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Author: 


Bureau  of  Municipal 
Research... 

Title: 

IVIaking  a  municipal 
budget 

Place: 

[New  York] 

Date: 

[1 907] 


Qs-&imfc' 


MASTER    NEGATIVE   » 


COLUMBIA  UNIVERSITY  LIBRARIES 
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Bureau  of  municipal  research,  Nexo  York, 

Making  a  municipal  budget,  functional  accounts  and  opera- 
tive statistics  for  the  Department  of  health  of  Greater  New 
York;  prepared  and  published  by  the  Bureau  of  municipal 
research,  New  York,  1907  ...     [New  York,  1907, 

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DAMAGED  PAGE(S) 


vlAKING   A   MUNICIPAL   BUDGET 


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1  I 


FUNCTIONAL  ACCOUNTS  AND  OPERATIVE  STATISTICS 


FOR    THE 


DEPARTMENT  OF  HEALTH  OF  GREATER  NEW  YORK 


». 


•       «i 


PREPARED  AND   PUBUSHED 

BY  THE 

BUREAU  OF   MUNIGIPAI,   RESEARCH 

New  York,   1907 


A  limited  number  of  copies  of  this  report  may  be  obtained  at 

50    CENTS  EACH 


IISTIDEX 


Accounts,  department  of  health,    1906 25-2* 

Defects  in  and  revision  of 10,  27-3 

Segregation  ledger 27,  30,  156-16' 

Cost  vs.  disbursement,   expense  vs.   expenditure  accounting .10,  n,  27,  28 

Commissioners  of,  and  service  records 21 

Aldermen  demand  classification  of  budget,  1906 1 1,  36 

Budget :  effective  publicity  through 3,5 

Defects  in  and  revision  of 6,  9,"  30 

Advantages  of  classification 7,  1 1,  12,  36,  37 

Conference  committee  on  revisiow.  0!,^  X908 . , 1 1 

Estimates  should  be  explained. . . n,  i^  16 

Bureau's  brief  for  segregated  budget,  1906. 1 1.  34,  35,  39 

Titles  of  appropriations,  1906,  1907,  1908 38-44 

Service  reports  in  connection  with. 15,  16 

Bureau  of  Municipal  Research  :   history,  purposes Cover,  5 

Trustees  and  administrative  council ' 3 

Brief  for  segregated  budget,  1906. u,  34,  35,  39 

Conference  committee  with  department  of  finance,  1907 ij 

Death  rate  vs.  case  rate  as  test  of  public  health 22  24 

Control  through  accounts  and  records 12,  i^^  27-30,  32 

Estimate  and  apportionment,  board  of .11,  34,  35,  37 

Exhibits  (bmitted  from  abridged  edition) 

1  Bureau's  brief  for  segregated  budget,  1906 34,  35 

2  Resolutions,  (a)  board  of  aldermen,  and  (b)  board  of  estimate  and 

apportionment,  1906,  favdring  segregated  budget 36,  37 

3  Appropriation  titles,   health  budget,  (a)  1906,   (b)  suggested  by 

Bureau  for  1907,    (c)  actual,  1907,  (d)    1908 38-45 

4  99  blank  forms  for  health  report. 46-153 

5  Suggested  form  for  report  of  expenditures.. 154,  155 

6  Segregation  ledger,  proposed  classification 156-165 

7  Scoring  cards  :  dairies,  creameries,  milk  shops 166-171 

Function  as  basis  of  budget,  accounts  and  records 9-14,  26,  i8,  29,  30 

Health,  department  of  :  functions  of 7,  ^3?  14 

Public  interest  starting  point  for  budget  revision 7f  9,  34i  35 

Reports  and  records  in  1906,  and  revision  of. lo-ta,  15,  17-19,  21,  23,  25,  46=-i53 

,    Ledger  segregation,  1906,  1907 27-30;  156-165 

Milk  inspection,  scoring  cards,  etc 56-67,  166^171 

Reports  and  records  of  service  rendered :  publicity 5,  6 

Requisite  to  intelligent  budget 14-16 

DiflSculties  of  securing  accuracy 19-21 

Of  department  of  health 10,  17-19,  25 

As  revised  in  1907,  method  of  devising 12,  21,  22,  46-153 

Lead  to  improved  organization  .^ . . .  ,^. , 30,  31 

School  inspection^  medical  examination,  etc 15,  16,  92-105 


MAKING   A   iVlUNICIPAL   BUDGET 


PREPARED   AND    PUBLISHED 

HY    THI-: 

BURKAU    OF    MUNICIPAL    RESEARCH 

New  York.    1907 


A  limited   number  of  copies  of  this  report  may  be  obtained  ai 

50    CENTS   EACH 


Coluinbta  (Hnitif  wttp 

mtlieCtlpoflrtogork 


LIBRARY 


MAKING   A   MUNICIPAL   BUDGET 


^4*    '    ^ 


FUNCTIONAL  ACCOUNTS  AND  OPERATIVE  STATISTICS 


FOR    THE 


DEPARTMENT  OF  HEALTH  OF  GREATER  NEW  YORK 


PREPARED  AND  PUBLISHED 

BY  THE 

BUREAU   OF  MUNICIPAL  RESEARCH 

New  York,  1907 


A  limited  number  of  copies  of  this  report  may  be  obtained  at 

50    CENTS   EACH 


'i 


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PREFACE 

This  is  the  first  of  a  series  of  reports  by  the  Bureau  of  Municipal  Rc^ 
search  on  the  general  subject  of  Budget  Making.  It  is  addressed  to  tax- 
payers who  wish  to  know  what  benefits  their  taxes  buy  and  what  community 
needs  are  not  provided  for;  to  municipal  officers  who  wish  to  obtain  public 
support  for  efficient,  far-seeing  administration ;  to  civic  bodies,  who  aim,  by 
informing  public  opinion,  to  improve  municipal  government;  and  to  phil- 
anthropists seeking  opportunity  for  productive  fields  of  benefaction. 

The  successive  steps  in  the  inquiry  are  set  forth  chronologically  for 
the  light  they  throw  on  methods  of  municipal  research  and  of  co-operatioit 
with  city  officials. 

BUREAU   OF  MUNICIPAL   RESEARCH 


Trustees 

Edwin  R.  A.  Seligman,  Chairman 
Frank  Tucker,  Vice-Chairman 
R.  Fulton  Cutting,  Treasurer 
Richard  Watson  Gilder 
George  McAneny 
Albert  Shaw 
Carroll  D.  Wright 


Administrative  Council 

William  H.  Allen,  Secretary 
Henry  Bruere,  Director 
Frederick  A.  Cleveland,  Technical 

Director 
Rufus  E.  Miles 
William  R.  Patterson 
Paul  C.   Wilson 


^-ir 


Introduction 

No  document  can  tell  in  such  condensed  form  so  many 
significant  facts  about  community  needs  and  govern- 
ment efforts  to  meet  those  needs  as  a  properly  construct- 
ed budget.  In  view  of  this  fact  it  is  rather  surprising 
that  budget  making  as  a  method  of  publicity  has  here- 
tofore been  generally  neglected  in  American  cities.  Per- 
haps it  is  because  we  are  accustomed  to  think  of  the 
characteristics  of  publicity  rather  than  its  source  or 
method.  We  describe  certain  qualities  of  publicity  such 
as  intermittent  and  constant,  explosive  and  cumulative, 
whispered  and  advertised,  ineffective  and  effective;  but 
rarely  have  we  set  over  against  each  other,  the  publicity 
about  government  that  originates  with  private  citizens, 
newspapers  or  magazines  and  that  other  publicity  about 
government  which  originates  with  governing  officials 
through  public  statements  and  published  reports.  The 
publicity  of  the  latter  kind  that  originated  with  New 
York  City^s  officials  in  1906,  more  particularly  with  its 
budget  makers,  only  added  to  confusion  and  helplessness 
on  the  part  of  the  public. 

Because  the  current  records  and  reports  of  various 
departments  were  not  so  kept  as  to  disclose  their  mean- 
ing readily,  the  greater  part  of  this  Bureau's*  effort 
from  January,  1906,  to  August,  1907,  has  been  directed 
to  securing  methods  of  accounting  for  moneys  spent  and 
for  recording  work  done  that  would  clearly  and  promptly 
show  the  results  of  municipal  activity  in  its  various 
phases.  Its  emphasis  upon  system  rather  than  personnel, 
upon  provable  results  rather  than  pretentions,  has  been 
due  to  the  double  conviction,  (a)  that  inefficiency  will 
almost  invariably  be  found  together  with  unbusiness-like 
organization  and  methods;   (b)   that  the  most  effective 


Publicity 

by 
Officials 


Original 
Sources  of 
Effective 
Publicity 


♦Known   as  the   Bureau   of  City  Betterment,  January,  1906,  to  May  3,  1907;  then 
Incorporated  as  the  Bureau  of  Municipal  Research  with  the  following  program: 

To  stromote  efficient  and  economical  municipal  government ;  to  promote 
the  adoption  of  scientific  methods  of  accounting  and  of  reporting  the  details 
of  municipal  business,  with  a  view  to  facilitating  the  work  of  public  offi- 
cials ;  to  secure  constructive  publicity  in  matters  pertaining  to  municipal 
problems ;  to  collect,  to  classify,  to  analyze,  to  correlate,  to  interpret  and  to 
publish  facts  as  to  the  administration  of  municipal  government. 
The  Bureau  will  gladly  answer  questions  that  may  be  prompted  by  this  report 


Sadget 

iStady 

-Astguat, 


Methods 
<«f  Urging 
Sudget 
SteXorm 


MAKING  A  MUNICIPAL  BUDGET 

publicity  must  proceed  from  records  and  accounts  de- 
vised for  the  purpose  of  informing  responsible  officers 
and  the  public  as  to  government  results  and  community 
needs.  In  its  study  of  street  paving  contracts,  depart- 
ment of  street  cleaning,  city  owned  houses,  and  the  ad- 
ministration of  the  office  of  the  president  of  the  borough 
of  Manhattan,  it  learned  by  a  careful  analysis  of  condi- 
tions that  the  city's  method  of  attending  to  the  various 
duties  involved  was  calculated  to  conceal  and  promote 
inefficiency,  confusion  and  corruption.  Facts,  and  con- 
clusions based  upon  facts,  found  from  the  start  a  cordial, 
appreciative  welcome  at  the  hand  of  city  officials,  civic 
leaders,  editorial  writers  and  the  general  public,  and  led 
invariably  to  improvement  of  conditions  described.  It 
seemed  advisable,  therefore,  in  August,  1906,  to  call  at- 
tention to  the  city's  hit-or-miss  method  of  making  its 
budget;  i.  e.,  of  distributing  its  annual  tax  levy  of  $130,- 
000,000,  voted  for  the  discharge  of  those  duties  that 
have  grown  out  of  common  acts,  common  needs  and  com- 
mon properties. 

It  would  have  been  easy  to  criticise  on  theoretical 
grounds  the  existing  method  of  budget  making.  The 
community  would  not  have  been  surprised  to  be  told 
that  $130,000,000  was  voted  away  annually  without  prop- 
er questions  being  asked  as  to  the  services  to  be  pur- 
chased. All  observant  citizens  knew  that  department 
heads  asked  for  more  than  they  needed  in  the  hope  of 
getting  a  substantial  increase  in  spite  of  the  arbitrary 
horizontal  cut  of  ten  to  twenty  per  cent  almost  invariably 
made  by  the  board  of  estimate  and  apportionment.  Num- 
erous stories  could  have  been  told  of  money  asked  and 
voted  for  one  purpose  that  had  been  used  for  entirely 
different  purposes.  Next  year's  revenues  were  mort- 
gaged to  do  this  year's  work,  but  the  public  did  not 
realize  that  this  "penny  wise,  pound  foolish"  practice  re- 
duced year  by  year  the  purchasing  power  of  the  dollar 
paid  for  taxes.  Supplementary  appropriations  and  trans- 
fers from  one  fund  to  another  concealed  the  weaknesses 
of  the  bucTget,  and  rarely  came  to  light  in  the  succeeding 
budget;  consequently,  popular  phases  of  work  were  em- 
phasized at  budget  sessions,  and  appropriations  less  popu- 
lar or  questionable  were  rushed  through  at  regular  meet- 


i      ^ 


■H 


1 


HEAWH  BUDGET,  NEW  YORK  CITY 

ings  of  the  board  of  estimate  and  apportionment  when 
crowded  calendars  prevented  adequate  consideration.  No 
serious  doubt  would  have  been  expressed  had  the  Bureau 
claimed  that  at  least  $10,000,000  could  be  saved  annually 
by  introducing  business-like  methods  of  budget  analysis. 
But  such  a  discussion  of  the  abstract  principles  that  should 
govern  budget  making  even  when  illustrated  by  existing 
defects  would  have  resulted  in  little  if  any  action.  Real- 
izing this,  and  appreciating  the  educational  advantage  of 
an  object  lesson,  the  Bureau  set  out  to  prepare  a  budget 
for  one  department  in  a  way  that  would  demonstrate 
the  value  of  a  clear  showing  of  just  what  work  it  was 
proposed  to  do  with  the  funds  requested.  For  reasons  of 
expediency  it  was  decided  to  present  the  claims  of  the 
health  department,  which  happened  at  this  time  to  be  in 
particular  need  both  of  funds  and  of  public  support. 

In  thus  approaching  budget  making  from  the  stand- 
point of  health  administration,  the  Bureau  aimed  to  avail 
itself  of  the  line  of  easiest  access  to  public  attention  and 
conviction.  No  one  has  the  courage  to  defend  inefficient 
health  administration.  No  one  says  "Let  well  enough 
alone"  when  told  that  health  officers  are  neglecting  their 
duties.  Everyone  has  a  vital  interest,  that  he  can  be 
easily  taught  to  picture,  in  the  adequate  protection  of 
public  health.  Finally  the  department  of  health  was  in 
position  to  make  out  a  clear  case  before  any  jury ;  it  had 
definite  work  to  do  and  could  clearly  describe  why  that 
work  should  be  done.  Therefore,  it  was  decided  to  use 
the  appealing  power  of  health  needs  to  illustrate  the 
principle  that  should  govern  budget  making  for  all  de- 
partments. As  is  told  on  page  11,  the  fiscal  authorities 
responded  by  committing  themselves  at  once  to  the  propo- 
sition that  henceforth  in  New  York  City  money  shall 
not  be  voted  until  the  fiscal  authorities  and  the  public 
are  told  for  what  purposes  the  money  will  be  used,  how 
much  was  used  for  similar  purposes  last  year  and  why 
the  decrease  or  increase,  if  any,  in  the  amount  of  work 
proposed. 

The  board  of  health  was  prepared  to  welcome  the 
Bureau's  request  for  co-operation  in  framing  a  health 
budget  based  upon  a  clear  analysis  of  the  city's  health 
needs  as  shown  by  the  department's  experience.    During 


Approach 

via 
Health 
Needs 


8 


Why  Health 
Officers 
Welcomed 
Suggestion 


MAKING  A  MUNICIPAL  BUDGET 

the  winter  and  summer  of  1906,  the  pubHc  mind  had  been 
greatly  agitated  over  various  conditions  said  to  be  men- 
acing public  health.  Milk  was  dangerous  because  con- 
taminated; lodging  houses  were  spreading  tuberculosis 
and  other  diseases ;  grave  fears  were  entertained  because 
the  sources  of  water  and  ice  supply  were  contaminated  ; 
hundreds  of  thousands  of  children  were  said  to  be  in 
need  of  medical,  dental  and  ocular  care;  streets  were 
littered  with  rubbish;  garbage  was  tardily  collected; 
black  smoke  was  polluting  the  air  day  and  night;  an 
anti-noise  society  became  necessary ;  impure  drugs,  meats 
and  other  foods  were  sold  in  violation  of  state  and  na- 
tional laws.  The  department  of  health  was  in  the  habit 
of  meeting  complaints  in  two  ways:  (i)  It  protested 
that  it  had  insufficient  funds.  (2)  To  correct  the  evils 
complained  of  most  bitterly  in  the  morning  it  borrowed 
men  engaged  in  correcting  other  evils,  only  to  learn  in  the 
afternoon  that  Paul  had  been  crippled  to  help  out  Peter. 
A  strong  appeal  by  a  private  society  led  the  mayor  be- 
fore leaving  on  his  vacation  to  ask  the  unanimous  con- 
sent of  the  board  of  estimate  and  apportionment  to  act 
upon  a  resolution  giving  the  department  of  health  $100,- 
000  for  hot  weather  emergency  work ;  by  August  it  was 
obvious  that  the  greater  part  of  the  money  had  been 
absorbed  by  activities  not  contemplated  in  the  appropria- 
tion. For  several  years  prior  to  the  inquiry  the  board 
of  estimate  and  apportionment  in  fixing  the  amount  of 
the  health  budget  had  made  a  cut  of  18%  to  42%  in  the 
estimates  presented  by  the  board  of  health.  In  doing  this 
the  fiscal  authorities  had  made  no  attempt  to  determine 
the  exact  needs  of  each  of  the  many  functions  exercised 
by  the  department  of  health.  They  had  required  no 
statement  of  cost  of  conducting  these  several  functions, 
and  no  contrasting  exposition  of  work  accomplished. 
Arbitrarily  assuming  an  exaggeration  in  the  department's 
estimate  the  fiscal  authorities  arbitrarily  shaved  down 
the  requests  in  determining  the  amount  to  be  apportioned 
in  the  budget.  While  the  department's  experience  justi- 
fied the  hope  that  supplementary  appropriations  would 
be  made  and  revenue  bonds  issued,  it  never  knew  in  what 
amounts  these  additional  funds  would  be  granted  or  how 
far  short  they  would  fall  of  the  department's  needs.  The 


i.     • 


-'^    /?-• 


f 


HEALTH  BUDGET,  NEW  YORK  CITY 

doling  out  of  appropriations  bit  by  bit  through  the  year 
prevented  the  department  from  utilizing  to  the  best  ad- 
vantage what  funds  it  did  receive.  In  laying  out  its 
plans  of  work  at  the  beginning  of  each  year,  the  depart- 
ment was  placed  in  the  dilemma  of  immediately  curtail- 
ing its  activities  to  correspond  with  its  limited  appropria- 
tion, or  of  continuing  its  work  on  a  scale  larger  than  the 
budget  justified,  on  the  chance  of  securing  bond  issues 
when  the  regular  appropriation  was  exhausted.  Under 
such  circumstances,  the  department  of  health  could  adopt 
no  far-reaching  policy  or  plans  with  any  assurance  of  car- 
rying them  out.  In  other  words  the  health  department 
lived  from  hand  to  mouth,  borrowing  from  July  to  do 
April's  work,  prevented  by  budget  methods  from  being 
efficient  and  economical,  from  taking  at  each  season 
the  stitch  in  time  that  saves  nine.  For  the  foregoing  rea- 
sons the  commissioner  was  prepared  to  see  the  force  of 
the  Bureau's  suggestion  that  the  best  way  to  increase 
funds  and  to  earn  public  confidence  was  to  show  clearly 
what  the  community  needed  and  to  place  squarely  upon 
the  fiscal  authorities  the  responsibility  for  failure  to  un- 
dertake the  entire  amount  of  health  work  required. 

After  consultation  with  the  Mayor,  Commissioner  Dar- 
lington agreed  to  the  plan  of  the  Bureau  and  cordially 
facilitated  its  execution.  The  staflF  of  the  department  co- 
operated in  every  way  with  the  Bureau's  investigators. 
The  medical  officer,  Dr.  Herman  M.  Biggs,  the  commis- 
sioner's chief  assistant,  Dr.  Walter  Bensel,  and  various 
division  heads  welcomed  the  obvious  opportunity  to 
strengthen  the  department's  case  and  contributed  most 
valuable  suggestions. 

Proposed  Sttidy  of  Health  Department 

The  statement  of  the  health  situation  contemplated 
by  the  Bureau  aimed  to  cover  the  following  points : 

(i)  The  functions  or  lines  of  activity  maintained  by 
the  department  in  answering  the  questions :  What  kinds 
of  work  is  the  department  trying  to  do;  what  forms  of 
danger  is  it  planning  to  guard  against? 

(2)  The  service  rendered  in  each  during  the  latest 
period  for  which  reports  were  available. 


Penalties 

for 
Hit-or-Mlss 
Budget 
Methods 


Elements 
to   be 
Studied 


lO 


Service 
Data  Not 
Obtainable 


Cost 
Data 
Not 
Obtainable 


MAKING  A  MUNICIPAL  BUDGET 

(3)  Cost  of  maintaining  each  activity  or  function. 

(4)  A  comparison  of  service  with  cost  in  each  activity 
or  function. 

(5)  Proposed  expense  for  each  activity  or  function 
for  the  ensuing  year  with  detailed  estimates  and  compari- 
sons and  with  reasons  for  changes. 

Before  an  accurate  statement  of  the  functions  and  ac- 
tivities of  the  department  could  be  made,  an  extended 
inquiry  was  found  to  be  necessary,  inasmuch  as  the  or- 
ganization,— the  assignment  of  duties,  and  the  distribu- 
tion of  responsibility  among  officers  and  subordinates- 
was  not  explicit  and  did  not  appear  on  the  records. 

The  reports  and  records  of  service  performed  were  ill- 
adapted  to  meet  the  demands  for  information  needed  in 
budget  making.  The  prevailing  forms  of  annual  report 
did  not  present  all  the  significant  facts;  the  relation  be- 
tween facts  given  was  not  made  clear;  the  items  were 
sometimes  in  terms  ambiguous  to  anybody  but  the  depart- 
ment officials,  not  infrequently  being  understood  by  no 
one  but  the  clerk  who  compiled  them;  the  figures  were 
obtained  from  fragmentary  records;  statements  of  fact 
that  related  to  each  other  were  scattered  through  the  re- 
port, their  value  being  lost  because  there  was  no  index; 
when  found,  the  data  were  in  such  different  form  that 
lomparison  was  difficult  or  impossible.  Likewise  the 
accounting  system  of  the  department  did  not  readily 
lend  itself  to  obtaining  information  as  to  cost.  The  classi- 
fication in  use  was  by  "funds'*  or  "appropriation  ac- 
counts" which  in  most  cases  did  not  represent  clearly  de- 
fined functions  or  activities  of  the  department.  For  ex- 
ample, out  of  the  school  inspection  fund  were  paid  not 
only  the  medical  inspectors  of  schools  but  the  school 
nurses  and  the  so-called  summer  corps,  consisting  of  phy- 
sicians and  nurses  engaged  in  house-to-house  visits  to  dis- 
cover babies  suflfering  from  summer  complaint,  and  to 
instruct  mothers  in  their  care. 

Furthermore,  the  fund  or  account  to  which  an  item 
of  expenditure  was  charged  did  not  necessarily  indicatt 
what  function  of  the  department  actually  received  the 
benefit  of  it.  In  salary  accounts,  an  employee's  salary 
might  be  charged  to  a  function  to  which  only  a  part  or 
none  of  his  services  were  devoted.     Sixty-eight  physi- 


I.'    * 


"^  j/' 


* 


',  I  f-^ 


; 


HEALTH  BUDGET,  NEW  YORK  CITY 

cians,  for  example,  having  been  charged  to  "school  in- 
spection" were  never  engaged  in  school  inspection.  Simi- 
larly supply  accounts  failed  to  show  in  what  proportions 
the  different  activities  consumed  supplies  that  were  pur- 
chased in  bulk.  Even  when  fund  did  correspond  with 
function — when  supplies  were  used  only  by  the  activities 
to  which  they  were  charged — the  expenditure  shown  in 
the  supply  accounts  frequently  did  not  represent  true  cost 
for  the  reason  that  the  books  showed  money  paid  out 
for  supplies  and  not  supplies  used;  to  assume  that  sup- 
plies purchased  are  supplies  consumed  is  analagous  to 
assuming  that  money  deposited  in  a  savings  bank  is 
money  spent — a  fallacy  apparent  to  the  novice.  From  the 
financial  records  used  in  August,  1906,  a  complete  and 
accurate  statement  of  costs  for  the  different  functions 
could  not  be  obtained. 

In  view  of  these  difficulties  it  was  seen  to  be  impossible 
in  six  weeks  to  formulate  a  restatement  of  the  entire  de- 
partmental estimate,  together  with  supporting  statements 
of  cost  and  service,  in  time  for  the  budget  for  1907,  which 
must  be  ready  for  consideration  by  the  board  of  esti- 
mate and  apportionment  in  October. 

It  was,  however,  found  to  be  feasible,  with  some  inves- 
tigation, to  classify  salaries  and  incidental  expenses  ac- 
cording to  function,  that  is,  according  to  departmental 
activities;  and  since  salaries  and  incidental  expenses 
constituted  about  two-thirds  of  the  total  expenses  of  the 
department  of  health  it  was  determined  to  present  a 
classified  statement  of  them  to  the  board  of  estimate 
and  apportionment  to  function,  that  is,  division  of  work. 
The  resolutions  of  the  board  of  estimate  and  apportion- 
ment and  the  board  of  aldermen  are  repeated  (Exhibit 
3)  because  it  is  considered  that  in  the  evolution  of  the 
American  budget  those  documents  will  prove  to  be  epoch- 
making. 

That  the  purpose  to  put  the  principle  into  operation 
has  not  been  lost  sight  of  is  evidenced  (a)  by  the  circu- 
lar letter  issued  May  28th,  1907,  by  the  finance  depart- 
ment to  the  heads  of  departments,  calling  their  attention 
to  the  above  resolutions  and  requesting  them  to  confer 
with  the  comptroller  on  the  form  of  their  estimates,  and 
^b)   by  the  comptroller's  appointment  of  a  joint  com- 


II 


Expedient  for 
Budget  of 
1907 


Success 

of 
Expedient 


12 


Improved 
System  of 
Accounts 


Revised 
Service 
Records 
Adopted 


MAKING  A  MUNICIPAL  BUDGET 

mittee  of  representatives  of  the  Bureau  and  the  depart* 
ment  of  finance  to  prepare  classifications  for  the  budgets 
of  several  of  the  major  departments,  i.  e.,  water  supply, 
gas  and  electricity;  Bellevue  and  allied  hospitals;  de- 
partment of  street  cleaning;  health  department;  police 
department. 

Rcof  gfanhation  of  Administrative  Records  and  Accounts 

After  the  adoption  of  the  budget  for  1907,  the  Bureau, 
pursuing  its  original  purpose,  suggested  that  the  depart- 
ment make  such  changes  in  administrative  records  and 
accounts  as  would  enable  it  to  report  readily  and  ac- 
curately both  service  rendered  and  the  cost  of  maintain- 
ing each  function.    In  April,  1907,  following  numerous 
conferences,  important  modifications  in  methods  of  ac- 
counting were  recommended,  (a)  revised  classification  of 
accounts  corresponding  accurately  to  functional  activities, 
in  which  disbursements  should  be  charged  strictly  ac- 
cording to  their  use;  and  (b)  a  system  of  store  accounts 
which,  in  connection  with  inventories,  would  render  state- 
ments of  cost  possible  for  any  desired  period.    The  form- 
er recommendation,  in  its  main  lines,  has  been  adopted 
and  is  being  put  into  effect  for  the  coming  budget.    The 
second  recommendation  has  not  yet  been  adopted.     (See 
page  29).     The  problem  of  modifying  the  service  re- 
ports and  records,  it  will  be  seen,  had  to  be  approached 
somewhat  differently  from  that  of  the  accounts.    In  the 
latter,  it  was  perfectly  clear  what  should  be  shown,  i.  e., 
the  costs  properly  chargeable  to  each  function.    The  only 
question  was  as  to  the  mechanism  by  which  to  show  it 
most  satisfactorily.     With  the  service  reports,  however, 
the  primary  question  was :    What  are  the  significant  facts 
that  should  be  shown ;  by  what  standard  can  success  or 
failure  be  judged  in  each  line  of  activity?    The  question 
of  mechanism  was  here  secondary.     A  series  of  con- 
ferences with  the  various  executive  officials  of  the  depart- 
ment was  therefore  necessary  to  determine  the  essential 
facts  of  its  activities.    The  result  of  these  conferences 
was  the  series  of  tabular  forms  presented  in  Exhibit  4  of 
this  pamphlet,  which  have  been  adopted  by  order  of  the 
commissioner  for  the  purposes  of  the  annual  report.  The 


•f  • 


HEALTH   BUDGET,   NEW  YORK   CITY 

changes  in  office  records  necessary  to  meet  the  new  re- 
port forms  are  now  in  progress. 

With  the  information  thus  provided  for,  the  Bureau 
believes  that  the  public,  through  its  immediate  financial 
representative,  the  board  of  estimate  and  apportion- 
ment, will  be  enabled  to  render  a  far  more  intelligent 
answer  to  the  annual  question :  How  much  ought  New 
York  City  to  spend  for  the  purpose  of  maintaining  the 
public  health? 

Analysis  of  Lines  of  Activity 

It  is  tlie  duty  of  the  department  of  health,  as  out- 
lined by  the  charter,  to  provide  by  suitable  measures  and 
by  means  of  the  sums  appropriated  to  its  uses,  conditions 
looking  *'to  the  preservation  of  human  life,  or  to  the  care, 
promotion  and  protection  of  health"  in  the  City  of  New 
York.  The  lines  of  activity  which  the  department  is 
maintaining  constitute  its  answer  to  the  question: 
"What  are  the  health  needs  of  the  city  that  are  most  im- 
portant to  meet  ?"  The  need  that  the  milk  supply  be  pure 
is  recognized  in  the  inspection  of  milk;  to  tlie  need  for 
reducing  the  prevalence  of  tuberculosis,  the  department's 
response  is  the  maintenance  of  district  inspection,  clinic 
and  sanatoria.  The  department  is,  of  course,  aware  of 
needs  which  have  not  yet  been  met  by  any  organized  ef- 
fort on  its  part,  owing  to  the  fact  that  its  resources  are 
not  unlimited.  It  is  fair  to  say,  however,  that  the  activi- 
ties now  maintained  are  an  expression  of  its  judgment 
as  to  the  measures  most  immediately  necessary  to  the 
public  health. 

The  lines  of  its  work  that  constitute  direct  publiq  ser- 
vice are  as  follows: 
General  sanitary  inspection 
Milk  inspection 
Food  inspection 

Inspection  of  mercantile  establishments 
Lodging  house  inspection 
Shore  inspection 

District  medical  inspection  of  contagious  diseases 
Medical  inspection  of  school  children 
Summer  corps 


13 


General 
Functions 

of 
Department 


Functional 
Activities 


M 


Administrative 
Divisions 


MAKING  A  MUNICIPAL   BUDGET 

Vaccination 

Disinfection  (including  goods  wagon  service)  ! 

Inspection  of  animals 

District  inspection  of  communicable  diseases 

The  tuberculosis  clinics  .' 

Willard  Parker  and  reception  hospitals 

Riverside  hospital 

Kingston  avenue  hospital 

(including  ambulance  service) 
Otisville  sanatorium 
Trachoma  hospital 

Removal  of  dead  animals,  offal  and  night  soil 
Research  laboratory 

Chemical  laboratory  ' 

Vaccine  laboratory  ! 

Diagnosis  laboratory 
Department  stables 
Drug  laboratory 

The  executive  and  clerical  divisions  of  the  department 
are  the  offices  of  the 

Commissioner 

Secretary 

General  medical  officer 

Sanitary  superintendent  and  assistants 

Registrar  of  records  and  assistants 

Chief  clerk 

Assistant  chief  clerks 

Assistant  corporation  counsel 

In  each  of  these  various  lines  of  activity  there  is  the 
double  problem  (i)  of  arriving  at  costs  and  (2)  of  re- 
porting service  results  in  such  form  as  to  render  these,  as 
far  as  possible,  definitely  measurable  and  comparable 
with  costs. 

Reports  of  Service  Results 

The  answer  to  the  question,  "What  expense  is  in- 
curred to  maintain  a  given  activity?"  tells  little  without 
the  answer  to  the  corresponding  question,  "What  ser- 
Tice  is  rendered  by  means  of  that  expense?"  Whether 
administration  has  been  economical  or  wasteful  can  be 
determined  only  by  contrasting  cost  with  service  results. 


•  *     1     J 


s..< 


HEAI^TH  BUDGET,   NEW  YORK  CITY 

And  the  more  important  question,  "How  far  are  the 
health  needs  of  the  city  being  met,  irrespective  of  costs  ?" 
can  be  answered  only  through  the  reports  of  service. 
Wherefore,  the  necessity  for  reporting  service  results, 
especially  at  the  time  of  considering  the  budget. 

Recognition  of  this  necessity  is  found  in  various  pub- 
lic papers.  The  annual  circular  letter  issued  to  heads  of 
departments  by  the  board  of  estimate  and  apportion- 
ment calls  for  full  explanation  to  accompany  the  esti- 
mates, stating  the  reasons  for  any  increase  or  decrease 
in  the  amounts.  The  following  extracts  from  the  letter 
of  transmittal  accompanying  the  estimate  of  the  board 
of  health  for  the  year  1906  are  to  the  same  point: 

"The    board    of    health    most    urgently    requests 
your  critical  consideration  of  this  estimate,  for  they 
feel  that  the  more  you  investigate  the  requests  for 
the  various  funds  the  more  you  will  be  convinced 
that  they  are  reasonable  and  necessary,  and  that  the 
sums,    if   so   appropriated,   will   not   only  be   used 
wisely    but    their    use    will    result    in    great    and 
demonstrable  benefits  to  the  city.***    While  it  may 
appear  to  your  Honorable  Board  that  the  sums  ex- 
pended by  the  department  of  health  are  large,  the 
board  of  health  feels  confident  that  a  careful  study 
of  the  results  attained  will  convince  you  that  the 
cost  is  really  insignificant  as  compared  with   the 
benefits  secured.     **The  board  of  health  is  con- 
fident that  the  ratio  of  increase  in  the  annual  budget 
to  the  decrease  in  the  death  rate  will  surely  be  main- 
tained  should  your  Honorable  Board  consent  to  the 
award  of  our  estimate  as  herewith  transmitted." 
In  practice,  however,  department  estimates  reveal  little 
or  no  systematic  attempt  to  demonstrate  or  justify  their 
services  or  needs.     A  typical  example  of  the  "explana- 
tion" accompanying  department  estimates  is  the  follow- 
ing statement  in  the  budgetary  estimate  of  the  depart- 
ment of  health  for  the  year  1907 : 

"The  increase  of  $39,600  for  medical  school  in- 
spection, as  shown  above,  is  requested  to  pay  the 
salaries  of  thirty-two  new  medical  inspectors,  at 
$1,200  each,  distributed  among  the  various  boroughs, 
as  indicated  above,  and  of  one  additional  nurse,  at 


15 


Necessity 

of 
Reporting: 
Service 


Necessity 
Recognized 


No  Service 

Reports 

In  Connection 

With 

Budget 


i6 


ll 


Possible 

Service 

Report 

To 

Support 

Estimate 


MAKING  A  MUNICIPAL  BUDGET 

$i,20o,  in  the  borough  of  Manhattan.     These  are 

required  to  keep  pace  with  the  constantly  growing 

school  population  throughout  the  city.'* 

How  the  estimate  of  just  thirty-two  inspectors  and 

one  nurse  is  arrived  at  does  not  appear.    No  statement  is 

presented  to  show  the  results  of  the  work  previously 

performed  by  school  inspectors  or  to  prove  the  necessity 

of  any  additional  inspectors.      It    would    require    little 

more  space  and  would  convey  far  more  information,  to 

present  a  brief  table  like  the  following: 

1907  1908 

(Actual)  (Estimated 

and 

Proposed; 

Total  registration  in  public  schools ..  ^500,000     *6oo,ooo 

Number  of  children  examined 200,000      6oo,oc>o 

Percentage  of  total  reg-istratlon 40  100 

Number  needing  treatment. .  .* 60,000       180,000 

Per  cent  ag'e     of    those    examined    needing 

treatment SO  30 

School  physicians So  i6o 

'The  estimated  increase  in  the  number  of  inspectors 
necessary  to  examine  as  proposed   all  the  children   in 
the  public  schools  could  be  set  forth  as  follows :    With 
the  present  number  of  inspectors,  40%  of  the  children 
have  been  examined;  to  examine  all,  an  increase  of  150% 
in  available  service  is  therefore  necessary;  with  the  pres- 
ent assignment  of  schools,  inspectors  spend  on  an  aver- 
age only  about  60%  of  their  time  in  actual  service,  the 
remaining  40%  being  consumed  in  traveling  about.  With 
an  increase  of  100%  in  the  number  of  inspectors,  the 
time  wasted  in  traveling  could  be  cut  down  from  40% 
to  10%  of  the  time  of  each  inspector,  each  therefore 
performing  50%  more  work  for  the  same  compensation  * 
as  at  present.    In  other  words,  where  an  inspector  now 
examines  2,500  children  a  year,  he  could  then  examine 
3,750  a  year.     An  increase  of  100%  in  the  number  of 
inspectors  is  therefore  requested,  with  which  resources 
the  department  pledges  itself  to  examine  all  the  children 
in  the  public  schools."     Such  a  request    expressed    in 
definite  terms  would,  if  the  appropriation  were  granted. 


\i^. 


X 


•  The  figures  given  in  this  paragraph  for  purposes  of  illustration  are  entirely  fictitious 


HEALTH  BUDGET,   NEW  YORK  CITY 

become   a   matter  of  record  against  which   might   he 
checked  up  the  actual  performance  of  the  following  year. 
It  might  be  supposed  that  the  statistics  of  service, 
though  not  presented  (perhaps  because  not  demanded) 
with  the  departmental  estimate,  would  certainly  be  found 
in   the   annual   departmental   report.     An   examination, 
however,  of  the  last  published  annual  report  of  the  de- 
partment of  health   (that  of  1904)   shows  no  such  in- 
formation.   Out  of  some  fifty  pages  of  statistics  of  ser- 
vice presented  in  the  report,  twenty-two  are  devoted  to 
hospitals,  seven  to  a  list  of  vacated  premises  and  four 
to  legal  action  taken  on  violation  of  the  law,  leaving  thus 
only  about  ten  pages  to  the  important  work  of  the  divi- 
sion of  inspections  and  the  division  of  contagious  dis- 
eases.    The  amount  of  space  devoted  to  the  diflFerent 
lines  of  work,  it  is  seen,  is  not  in  any  way  proportioned  to 
their  relative  importance.     Moreover,  the  statistics  re- 
lating to  any  activity  have  to  be  sought  through  the  en- 
tire report,  being  scattered  and  unindexed,   sometimes 
€ven  being  impossible  of  identification  from  lack  of  titles. 
The  figures  for  the  various  boroughs,  if  .given  at  all,  are 
not  always  in  similar  form,  thus  rendering  comparison 
impossible,  either  of  one  year  with  another  in  the  same 
borough,  or  of  borough  with  borough.    Of  the  facts  nec- 
essary to   estimate   the   results   accomplished,   essential 
items  are  not  infrequently  missing. 

For  example,  the  statistics  of  milk  inspection  in  the 
annual  report  for  1904  are  in  several  sections  as  fol- 
lows : 

Page  67  Number  of  inspections  (unobtainable, 
being  included  with  inspections  of 
fruit,  food,  meat,  etc.,  in  a  grand 
miscellaneous  total)   587,682 

Number    of    specimens    of   milk   ex- 
amined       i5i22 

Number   of    specimens   of   milk   col- 
lected for  analysis 2,097 

Number  of  quarts  of  adulterated  milk 
destroyed    4^53^ 

Number  of  analyses i^oii 

«  Number  of  permits  issued i5>29o 

Number  of  arrests 56^ 


17 


Annual  Reports 
Defective  In 
Presenting 
Service   Results 


i8 


il 


Illustrations 

of 
Defective 
Reportins 


MAKING  A  MUNICIPAL  BUDGEl 

Number  of  persons  held  on  bail 373 

Number  of  persons  discharged 25 

No  indication  is  given  as  to  whether  those  facts  relate 
to  one  borough  or  to  the  entire  city.  Whatever  the  part 
of  the  city  to  which  they  do  relate,  the  information  be- 
comes of  little  value  from  the  lack  of  the  important 
item — number  of  milk  inspections.  Without  this  figure 
it  is  impossible  to  infer  whether  a  store  is,  on  the  average, 
inspected  once  a  week  or  once  in  six  months.  The  num- 
ber of  permits  is  furnished,  but  not  the  number  revoked ; 
no  indication  is  available  of  the  average  number  in  force 
which  the  inspectors  should  be  held  responsible  for  in- 
specting. Why  the  number  of  analyses  is  more  than  one- 
half  the  number  of  specimens  collected  for  analysis  is  a 
matter  of  conjecture,  as  is  also  the  number  of  analyses 
showing  adulteration  and  therefore  necessitating  further 
action.  Finally,  nothing  is  stated  as  to  what  became  of 
the  167  persons  arrested  who  were  neither  discharged 
nor  held  on  bail. 

The  second  group  of  statistics  relating  to  milk  inspec- 
tion is  on  pages  79  and  80,  as  follows : 

Work  Performed  by  Milk  Inspectors 

Number  of  inspections 40,169 

Number  of  specimens  of  milk  examined 47,624 

Number  of  specimens  of  milk  collected 4,212 

Number  of  quarts  of  adulterated  milk  destroyed.  .28,621 

Number  of  arrests 408 

Number  of  persons  held  on  bail 338 

Number  of  persons  discharged 19 

Number  of  persons  dismissed i 

Number  of  persons  acquitted 2 

Number  of  sentences  suspended 52 

Number  of  trials 406 

Amount  of  fines  $7,340 

As  before  it  is  not  stated  whether  these  facts  refer  to 
one  borough  or  to  the  entire  city.  A  comparison  of  the 
figures,  however,  (p.  79  with  67),  leads  to  the  supposi- 
tion that  (the  totals  being  larger)  the  latter  group  ot 
inspections,  specimens,  etc.,  relates  to  the  entire  city,  and 
the  former  group  to  one  borough.  The  number  of  ar- 
rests, however,  being  smaller,  indicates  that  the  number 
of  arrests  given  in  the  first  group  probably  includes  some 


*, 


HEALTH  BUDGET,   NEW  YORK  CITY 

relating  not  only  to  milk  inspection,  but  to  other  lines  as 
well.  The  number  of  permits  issued,  revoked,  or  in 
force,  is  not  mentioned,  nor  the  results  of  analyses  of 
specimens  stated. 

On  page  153  appears  the  single  item: 

Permits  to  sell  milk 2,781 

Since  this  item  appears  in  a  table  directly  above  the 
signature  of  the  chief  sanitary  inspector  for  Manhattan, 
it  is  to  be  supposed  that  the  number  refers  only  to  that 
borough;  the  question  arises,  however,  when  comparing 
this  figure  with  the  number  of  permits  issued  as  given 
above,  15,299,  how  it  happens  that  Manhattan,  with  over 
half  the  population,  appears  to  have  issued  only  a  little 
over  one-sixth  of  the  entire  number  of  permits.  It  does 
not  appear  in  what  boroughs  the  inspections  were  made ; 
no  basis  is  given  for  estimating  the  average  frequency  of 
inspection  of  stores  or  of  wagons;  nor  is  the  number  of 
discovered  violations  related  to  the  frequency  of  inspec- 
tions. 

The  endeavor  to  obtain  the  facts  of  service  results  for 
budget  purposes  encounters  two  main  difficulties  which 
should  be  recognized  at  the  outset,  the  first  relating  to 
definiteness  and  the  second  to  accuracy  For  budgetary 
purposes  it  would  be  most  satisfdctory  if  the  lesults  fol- 
lowing from  the  expenditure  of  certain  sews  of  money 
were  as  definitely  measurable  as  the  product  of  a  silk 
mill  or  a  nail  factory,  but  as  a  matter  of  fact,  it  is  quite 
otherwise.  It  is  often  difficult  and  sometimes  impossible 
to  ascertain  exactly  what  are  the  service  results  from 
given  expenditures.  As  to  the  immunization  of  well  per- 
sons exposed  to  diphtheria  by  the  administration  of  anti- 
toxin, it  can  readily  enough  be  stated  that  only  a  very 
small  number  contracted  the  disease;  but,  obviously  it  is 
quite  out  of  the  question  to  state  how  many  cases  were 
averted,  because  there  is  no  means  of  knowing  how  many 
cases  would  have  occurred  without  the  injections.  For 
much  of  the  work  of  the  department  of  health,  being 
in  greater  or  less  degree  of  a  preventive  character,  it 
is  impossible  to  state  absolutely  the  results.  Who  can 
assert  positively  how  many  cases  of  scarlet  fever  were 
prevented  by  means  of  quarantine  or  by  removal  of  cases 
to  hospitals  ?    In  such  cases  the  only  recourse  is  to  show 


19 


Difficulties 

of 
Securing 
Accurate 
Service   Reports 


20 


I  !; 


Means  Suggested 

for 
Meeting 
Difficulties 


MAKING  A  MUNICIPAL  BUDGET 

by  means  of  a  table  covering  a  series  of  years  that  there 
has  been,  parallel  with  the  increased  activity  of  the  board 
of  health,  a  gradual  decline  in  the  number  of  cases  oc- 
curring ;  that  the  epidemics,  when  they  do  come,  are  less 
serious  than  formerly.  Many  of  the  activities  of  the 
department,  however,  are  capable  of  measurement. 
Children  with  adenoids  are  much  more  likely  to  succeed 
in  their  school  work,  if  properly  operated  on,  than  if  left 
untreated ;  here  results  can  be  stated  in  percentage  tables. 
Each  line  of  activity,  it  was  found,  demands  a  standard 
of  its  own,  by  which  its  achievement  can  be  fairly  judged. 

A  further  limitation  upon  the  value  of  service  reports 
is  imposed  by  the  necessary  method  of  their  formulation, 
which  is  substantially  as  follows:  Either  the  depart- 
mental employee  or  his  immediate  superior  (a  foreman 
of  some  kind)  makes  a  report  of  work  performed  which 
becomes  a  part  of  the  office  records.  These  are  sum- 
marized and  re-summarized  for  the  purpose  of  each  suc- 
cessive superior  official  to  assist  him  in  his  administrative 
control  over  his  subordinates.  The  final  step  is  the  re- 
port of  the  commissioner  to  the  public,  represented  by 
the  mayor,  upon  the  work  of  the  department  as  a  whole. 
Throughout  there  is  constantly  in  operation  the  tendency 
on  the  part  of  the  one  rendering  the  report  to  present  the 
case  in  a  light  as  favorable  as  possible  to  himself.  The 
tendency  may  vary  in  degree  from  nothing  more  than 
a  discreet  failure  to  emphasize  disagreeable  facts  to  an 
actual  falsification  of  the  report.  To  reduce  to  a  mini- 
mum the  possibility  that  reports  will  conceal  or  withhold 
facts  damaging  to  the  employee,  division  or  department 
that  makes  the  report,  two  precautions  are  needed : 

(i)  The  forms  of  administrative  record  and  report 
should,  so  far  as  possible,  be  capable  of  ready  proof  and 
verification. 

(2)  They  should  be  currently  verified  through  exam- 
ination and  comparison  at  department  headquarters. 

(3)  Inspection  by  the  department  of  its  subordinates 
should  be  such  as  to  ascertain  whether  work  reported  on 
records  to  have  been  done,  is  actually  done ;  which  result 
requires  that  the  report  be  specific  as  to  time,  place,  etc. 
With  few  exceptions,  a  department  official,  who  is  hon- 
estly desirous  of  furnishing  efficient  service,  will  admit 


s 


*, 


HEALTH  BUDGET,  NEW  YORK  CITY  .    21 

the  necessity  of  such  reports  and  will  co-operate  in  de- 
vising them;  with  few  exceptions,  officials  who  profit 
from  misstatements  will  make  a  show  of  candor  and  will 
lack  the  courage  to  oppose  adequate  checks  on  records 
of  work  done. 

(4)  The  commissioners  of  accounts,  bureau  of  statis- 
tics, comptroller,  mayor,  or  whatever  office  is  financially 
responsible  to  the  tax  payer,  should  periodically  investi- 
gate departments  to  see  whether  or  not  proper  methods 
of  verification  are  in  force,  and  whether  these  adequate 
tests  are  constantly  applied.  In  other  words,  there  should 
be  an  examination  of  service  records  analagous  to  the 
examination  of  accounts  known  as  audit,  thus  provid- 
ing each  department  head  with  administrative  control 
over  his  subordinates,  and  the  city  as  a  whole  with  ad- 
ministrative control  over  department  heads.  By  these 
two  means,  the  reports  of  service  rendered  can  be  made 
sufficiently  accurate  to  serve  as  bases  of  estimate  in  fram- 
ing a  budget. 

Having  clearly  in  mind  the  above  mentioned  difficul- 
ties the  eflFort  was  made  to  provide  for  service  reports 
which  could  be  correlated  with  facts  of  expense  as  a 
basis  for  the  health  budget.  The  two  steps  in  the  process 
were  (i)  to  ascertain  the  significant  facts  and  (2)  to  de- 
vise forms  which  would  present  these  facts  most  clearly 
with  a  minimum  of  eflFort  to  the  reader.  To  each  of  the 
lines  of  activity  of  the  department  the  following  scheme 
was  applied: 

Analysis 

Specific  object  of  each  line  of  work;  also  the  ultimate  health  object,  if  that 

can  be  stated. 

Activities  designed  to  accomplish  that  object. 

Relation  of  activities  to  object.  In  what  common  terms  can  they  be  com- 
pared? Are  there  any  definitely  measurable  health  facts 
which  can  be  shown  to  follow  as  a  result  of  the  activities  in 
question?  If  not,  how  strong  a  presumption  can  be  estab- 
lished? 

Whenever  the  object  can  be  stated  in  measurable  terms,  independently  of 

the  amount  of  work  done,  there  should  be  such  statements, 
to  show  how  far  the  object  is  being  achieved. 


Method  of 
Devising 
Service 
Reports 


MAKING  A  MUNICIPAL  BUDGET 


Whenever  the  object  is  not  thus  independently  measurable,  a  presumption  as 

to  the  degree  of  success  should  be  established  by  means  of  a 
logical  arrangement  of  the  statements  of  amount  of  work 
done. 
From  such  analysis  of  the  several  lines  of  work,  the  forms  of  report 
were  devised.    Some  of  those  are  composed  of  facts  already  presented  by 
the  department,  but  rearranged;  others,  while  based  on  the  system  of  rec- 
ords now  maintained   in   the   department,   are   somewhat    fuller   in    state- 
ment than  those  of  the  present  annual  reports.    In  some  instances  they  re- 
quire new  methods  of  record  keeping,  though  not  necessarily  additional 
labor.    The  form  in  which  the  facts  are  presented  are  specially  designed  to 
facilitate  comparison  of  different  years,  each  borough  by  itself,  and,  so  far 
as  conditions  justify,  borough  with  borough,  it  being  only  through  such 
comparison  that  full  value  can  be  derived  from  statistics  of  service. 

For  some  of  the  administrative  divisions  mentioned  on  page  13  it  will 
be  observed  that  report  forms  are  not  included,  though  of  course  all  of 
them  are  provided  for  in  the  system  of  accounting.  The  purely  executive 
and  clerical  divisions,  while  necessary  to  the  achievement  of  results,  are 
not  susceptible  of  accurate  measurement  in  any  form  available  for  an  annual 
fcport.  Their  efficiency  must  be  judged  by  special  examinations.  Hence, 
no  tables  are  suggested  for  the  general  administrative  offices  of  the  com- 
missioner, secretary  of  the  board,  general  medical  officer,  sanitary  superin- 
tendent and  assistants,  registrar  of  records  and  assistants,  chief  clerk  and 
assistants,  the  assistant  corporation  counsel,  or  drug  laboratory. 

Consideration  of  several  of  the  lines  of  work  raises 
points  which  require  fuller  discussion.  It  will  be  noticed 
that  the  tables  dealing  with  infectious  diseases  have  made 
use  of  the  number  of  cases  reported  as  a  basis  of  com- 
parison, rather  than  the  number  of  deaths.  It  is  a  com- 
mon practice  among  boards  of  health  to  present  as  evi- 
dence of  the  success  of  their  work  figures  showing  a 
diminishing  general  death  rate.  The  main  reason  for 
this  is  doubtless  that  more  accurate  figures  can  be  ob- 
tained for  the  general  death  rate  than  for  any  other 
standard.  It  is  virtually  impossible,  in  New  York  City, 
to  escape  reporting  deaths;  while  of  cases  of  contagious 
and  communicable  diseases  actually  occurring  and  rec- 
ognized as  such,  the  proportion  reported  may  vary  con- 
siderable, borough  with  borough  month  with  month. 

These  are,  however,  several  inaccuracies  in  judgments 
as  to  efficiency  of  health  boards  based  upon  changes  in 
the  general  death  rate: 


X>eath  Rate  as 
Criterion 

of 
Public 
Sealth 


^        ♦ 


4 


t 


'%.' 


HEALTH  BUDGET,   NEW  YORK  CITY 

(i)  During  the  last  several  decades  there  has  been  in 
civilized  countries  a  steady  decline  in  the  general  death 
rate;  hence  a  decline  of  itself  cannot  in  any  particular 
locality  be  quoted  as  evidence  of  the  efficiency  of  the  local 
health  body. 

(2)  Case  fatality  differs  widely  among  different  dis- 
eases and  even  in  the  same  disease  under  different  cir- 
cumstances; hence  the  death  rate,  either  general  or  for 
any  single  disease,  cannot  accurately  indicate  the  amount 
of  sickness. 

(3)  Because  the  bulk  of  the  work  of  a  department  of 
health  is  not  curative  but  preventive,  far  reaching  reme- 
dies might  not  immediately  be  reflected  in  the  reduction 
of  mortality. 

As  a  matter  of  theory,  it  is  evident  that  the  success  of 
preventive  work  is  measured  by  the  degree  in.  which 
prevalence  of  disease  (morbidity)  is  diminished ;  success 
in  curing  disease  is  measured  by  a  decreasing  proportion 
of  cases  resulting  in  death  (case  fatality)  ;  while,  strictly 
speaking,  the  death  rate  (number  of  deaths  per  1,000  or 
10,000  of  population)  is  an  index  of  neither  prevention 
nor  cure.  It  becomes  a  question,  then,  of  how  far  the 
number  of  cases  reported  can  be  made  a  reliable  index 
of  the  number  of  cases  actually  occurring.  The  chief 
possibilities  of  statistics  being  inaccurate  would  seem  to 
be  the  following: 

(i)  Not  all  the  cases  of  any  disease  actually  occurring 
and  recognized  as  such  are  reported  by  physicians  to  the 
department  of  health.  The  proportion  a  reported  va- 
ries: (a)  according  to  the  seriousness  of  the  disease,  i  .e., 
the  likelihood  of  the  physician's  being  detected,  in  the 
event  of  the  patient's  death,  in  not  having  reported  the 
disease.  There  is  nowhere  the  completeness  of  reporting 
in  measles  that  there  is  in  small-pox.  This  is  serious 
where  the  figures  are  presented  for  each  disease  separate- 
ly, neither  combined  nor  compared  with  those  of  other 
diseases,  (b)  according  to  the  pressure  brought  to  bear 
upon  physicians  by  the  head  of  the  respective  divisions 
in  the  department  of  health.  This  invalidates  a  com- 
parison of  one  city  with  another:  but  within  one  city 
would  be  largely  overcome  by  care  on  the  part  of  the 
executive  officials  of  the  department  to  secure  uniform- 


93 


Cases 
Reported 

as 
Index    of 
Disease 


24 


Inaccuracies 
Due  to 
Case  Rates 


ft 


Comparison  for 
Series  of 
Years 


MAKING  A  MUNICIPAL  BUDGET 

ity  of  practice  in  the  different  boroughs;  (c)  according 
to  differences  of  policy  in  successive  periods  or  adminis- 
trations :  When  the  department  of  health  begins  a  more 
vigorous  campaign  against  any  specific  disease,  an  im- 
mediate result  is  likely  to  be  an  increased  thoroughness 
on  the  part  of  physicians  in  reporting  the  cases.  In  tu- 
berculosis, for  example,  the  number  of  cases  reported  to 
the  department  had  been  steadily  rising  every  year  for 
a  decade  or  more,  until  in  1906  in  Manhattan  the  new 
cases  reported  showed  a  decrease  from  those  of  1905. 
On  the  other  hand,  a  relaxation  of  pressure  by  the  de- 
partment for  any  reason,  would  result  in  a  falsely  fav- 
orable showing. 

(2)  Inaccuracies  of  diagnosis.  In  general,  the  de- 
partment of  health  accepts  the  diagnosis  of  the  attend- 
ing physician  who  reports  the  case ;  which  diagnosis  may 
prove  to  have  been  an  error.  Where  the  error  is  quite 
clear,  the  department  commonly  drops  the  report  as  "no 
case":  the  false  diagnoses  remaining  are  probably  not 
numerous. 

Precisely  to  what  extent  the  considerations  mentioned 
would  vitiate  the  use  of  the  case  rate  as  a  measure  of 
success,  over  a  series  of  years  (allowance  being  made,  of 
course,  for  epidemics),  it  is  impossible  to  assert.  The 
difficulties  are  chiefly  only  possibilities,  which  might  be 
largely  eliminated  or  allowed  for  in  practice.  On  the 
other  hand,  mortality  figures  could  never,  under  the  most 
favorable  circumstances,  be  a  closely  accurate  standard: 
they  should  be  used  only  for  lack  of  better.  "From  an 
economic  point  of  view,  sickness  is  more  important  than 
death;  it  is  the  amount  and  duration  of  sickness  rather 
than  the  mortality  that  tell  on  the  prosperity  of  the  com- 
munity. *  *  *  Mortality  statistics  necessarily  ignore  all 
that  precedes  the  close  of  life."  Since  the  use  of  the 
tables  proposed  does  not  involve  an  abandonment  of  the 
mortality  standards,  so  far  as  they  are  of  value,  they 
would  seem  to  afford  a  probable  gain,  with  no  possible 
loss. 

In  any  vital  statistics,  whether  of  prevalence  or  of 
mortality,  conclusions  must  of  course  be  based  on  the 
figures,  not  for  a  year  or  two,  but  for  a  series  of  years, 
the  length  of  time  varying  in  different  instances.    Five 


j»      * 


f»      « 


i  * 


r       '*. 


HEALTH  BUDGET,  NEW  YORK  CITY 

years  is  probably  as  short  a  time  as  will  indicate,  in  most 
instances,  any  tendency  that  can  be  regarded  as  signifi- 
cant: while  not  less  than  fifteen  or  twenty  years  would 
be  necessary  to  cover  the  periodical  waves  well  recog- 
nized in  contagious  diseases.  The  figures  for  long  periods 
belong  in  the  report  of  the  division  of  records,  and  are 
there  given  at  present  in  respect  to  mortality,  but  not  to 
cases  reported.  Short  term  statements,  however,  cover- 
ing perhaps  five  years,  may  well  be  given  directly  in 
connection  with  the  statements  of  work  done  by  the  di- 
visions of  contagious  and  communicable  diseases,  to 
be  applied  not  as  a  strict  standard  of  their  success  or 
failure,  but  as  an  approximate  indication  of  the  adequacy 
of  the  work  done. 

Service  Tables  Recommended  and  Adopted 

The  form  in  which  the  tables  are  presented  in  Exhibit 
4  is  that  which  would  have  been  used  in  the  annual  report 
for  1906,  if  such  a  plan  had  been  determined  upon  early 
enough  to  afford  the  necessary  figures.  In  putting  the 
plan  into  operation,  it  is  understood  that  many  of  the 
figures  for  past  years  are  not  now  available,  and  it  is 
not  suggested  that  any  undue  amount  of  effort  be  spent 
upon  securing  them.  The  records  necessary  to  the  form 
of  report  are  now  being  instituted  by  the  department  and 
will  in  a  few  years  provide  all  the  facts  called  for  by  the 
tables. 

The  Accountings  System  of  the  Department  of  Health 

In  1906  the  principal  records  maintained  by  the  de- 
partment of  health  were :  appropriation  and  fund  ledgers, 
order  register  and  liability  book,  excess  and  rebate  book, 
trial  balance  book,  contract  register  (tabulation  book) 
and  segregation  ledger. 

The  Appropriation  and  Fund  Ledgers  were  records 
kept  with  each  appropriation  and  bond  fund  against 
which  were  entered  all  vouchers  properly  chargeable 
thereto.  The  entries  were  made  after  the  vouchers  had 
been  finally  approved.  Each  book  was  columnar  in 
form,  showing  the  amount  of  the  voucher,  the  schedule 
number,  the  date,  the  name  of  the  firm  in  whose  favor 


25 


Short  Term 
Statements   of 
Limited  Value 


Principal 
Accounting 
Records,    1907 


Accounting 

Records 

Described 


MAKING  A  MUNICIPAL   BUDGET 

the  voucher  was  drawn,  the  division  or  bureau  for  which 
the  goods  or  materials  were  ordered,  the  voucher  num- 
ber, the  date  of  the  audit  of  the  bill  and  the  date  that 
the  voucher  was  sent  to  the  comptroller.  Instead  of 
transferring  unbalanced  accounts  of  one  year  to  a  new 
ledger  for  the  succeeding  year,  the  ledgers  themselves 
were  kept  open  pending  the  final  approval  of  vouchers 
chargeable  to  individual  accounts. 

The  Order  Register  and  Liability  Book  was  a  record 
in  which  were  entered  all  orders,  whether  contract  or 
non-contract,  sent  out  by  chief  clerks  in  response  to  requi- 
sitions   (formal  requests  properly  approved)    from  the 
several  divisions  and  institutions  desiring  supplies.     On 
receiving  these  requisitions,  the  supply  clerk  looked  them 
over  to  ascertain  whether  the  articles  had  been  contracted 
for  or  not,  and  whether  the  goods  requested  should  be 
obtained.     When  reviewed  and  initialed  by  the  supply 
clerk,  they  were  fon\^arded  to  the  chief  clerk,  who,  if 
approving  them  affixed  his  signature  or  initials.    Orders 
were  then  prepared  in  original  and  five  carbon  copies. 
The  original,  with  one  copy,  was  sent  to  the  firm  from 
which  the  goods  were  ordered — the  original  to  be  re- 
tained and  the  copy  to  be  delivered  with  the  goods;  a 
copy  was  sent  to  the  division  or  institution  requesting 
the  goods ;  a  copy  was  sent  to  the  inspector  of  supplies ; 
a  copy  was  forwarded  with  the  requisition;  and  a  copy 
was  held,  to  be  transmitted  with  the  bill  and  the  voucher 
to  the  department  of  finance.    The  amount  of  the  requi- 
sition was  posted  in  the  order  register  and  liability  book 
against  the  particular  fund  or  appropriation  drawn  upon ; 
at  the  same  time,  entry  was  made  of  the  requisition 
number,  the  date  of  the  order,  the  division  for  which  the 
goods  were  ordered,  the  firm   from  whom  the  articles 
were  ordered,  the  estimated  or  contract  cost  of  the 
goods,  the  actual  cost  of  the  goods,  the  date  received, 
the  date  of  audit,  the  number  of  vouchers  and  the  date 
forwarded  to  the  finance  department. 

Because  the  estimated  cost  was  often  in  excess  of  or 
less  than  the  actual  cost,  the  order  register  and  liability 
book  would  need  to  be  corrected  after  the  final  bill  was 
received.  Unless  the  difference  between  the  actual  cost 
and  the  estimated  cost  was  noted,  the  order  register 


.5 


« 


-V 


HEALTH  BUDGET,  NEW  YORK  CITY 

and  liability  book  would  show  too  little  or  too  much 
money  available  for  a  particular  fund,  and  the  appro- 
priation and  fund  ledger  would  indicate  frequently  that 
funds  were  available  when  funds  were  actually  ex- 
hausted, or  vice  versa.  All  such  excesses  or  rebates  were 
entered  in  the  Excess  and  Rebate  Book,  which  is  colum- 
nar in  form,  having  a  column  for  each  month  in  the  year 
and  a  page  for  each  appropriation  and  fund. 

The  Trial  Balance  Book  was  used  as  a  means  of  de- 
termining the  balance  of  appropriations.  In  it  were 
recapitulated,  in  condensed  form,  the  totals  of  charges 
against  individual  appropriations;  the  increases  and  re- 
ductions in  estimates;  the  net  estimated  charges;  the 
amount  appropriated  and  the  estimated  balance  of  appro- 
priations subject  to  order. 

The  Contract  Register  exhibited  in  tabulated  form: 
contracts  let  for  goods  and  materials  to  be  delivered  at 
stated  intervals  or  upon  requisition  and  order.  This 
record  was  kept  in  two  volumes,  one  for  supplies,  for 
which  bills  were  rendered  monthly,  such  as  milk,  meat, 
bread,  fish,  ice,  mineral  water,  fruits  and  vegetables;  the 
other  for  articles  delivered  upon  requisition.  In  the  case 
of  the  latter  a  pencil  memorandum  of  requisitions  made 
against  contracts  was  carried  until  a  bill  was  received 
when  the  pencil  memorandum  was  changed  to  ink  for 
permanent  record. 

The  Segregation  Ledger  was  a  statistical  record  to 
which  audited  vouchers  were  posted.  In  this  ledger  each 
class  of  expense  had  its  own  account  showing  against 
which  appropriation  or  fund  audited  vouchers  should  be 
charged.  The  accounts  in  this  segregation  ledger  were  in 
turn  summarized  according  to  appropriations  and  funds 


Defects  in  the  Accountingf  System  Employed  by  the 

Department  of  Health 

The  defects  in  the  accounting  system  above  outlined 
may  be  said  to  be  common  to  all  of  the  department  ac- 
counts of  the  city,  namely,  the  controlled  accounting 
records  were  those  which  pertained  to  appropriations 
and  funds  rather  than  to  cost  of  operation.     The  pri- 


Accountins 

Records 

Describe<i 


Defects 
Tj-pical   of 
City's 
Accounting 


1 


28 


i 


True 

Expense 
Records 
Not  Kept 


MAKING  A  MUNICIPAL  BUDGET 

mary  purpose  of  these  records  was  to  show  the  amounts 
drawn  from  each  item  of  appropriation  and  the  avail- 
able balance.  The  nearest  approach  to  an  expense 
record  was  a  segregation  ledger,  but  even  this  was  not 
a  true  expense  ledger  and  was  installed  as  a  convenience 
for  administrative  officers  rather  than  as  an  integral  part 
of  the  system. 

It  is  true  that  certain  items  or  groups  of  items  were 
segregated,  such  as  "horse  hire"  or  "supplies  and  con- 
tingencies;" but  instead  of  grouping  segregated  data 
about  branches  of  work  so  as  to  show  results  according 
to  administrative  divisions,  this  record  classified  and 
grouped  data  according  to  appropriations  and  funds.  It 
was  only  where  the  appropriation  or  fund  classification 
corresponded  to  a  proper  classification  of  function  and 
activities  that  the  grouping  had  an  administrative  value ; 
even  in  these  cases  a  true  statement  of  expense  was  not 
obtained,  owing  to  the  fact  that  the  records  showed  in 
what  amounts  supplies  were  purchased  rather  than  the 
amounts  used.  An  administrative  judgment  should  be 
based  on  the  cost  of  a  function  or  activity  within  a  given 
time  and  not  on  the  amount  expended  for  purchase  of 
stock;  such  administrative  judgment  was  not  made  pos- 
sible by  the  segregation  ledger. 

Another  serious  defect  of  the  segregation  ledger 
was  that  no  method  was  employed  for  currently  deter- 
mining its  accuracy.  Its  footings  and  balances  were  not 
compared  with  the  footings  and  balances  of  the  appro- 
priation ledger,  or  with  the  order  register  and  liability 
book.  Therefore,  helpful  as  this  ledger  was  to  an  ad- 
ministrative officer  wishing  to  learn  general  tendencies, 
it  was  not  a  reliable  guide  to  administrative  policy  and 
to  budget  making. 

Sugfgfcstcd  Improvement 

On  request  of  Comptroller  Metz  and  Commissioner 
Darlington,  the  Bureau  submitted  certain  constructive 
suggestions  looking  toward  the  establishment  in  the  de- 
partment of  health  of  an  expense  record  that  would 
give  to  the  administrative  heads  a  true  statement  of  the 
cost  of  each  activity.    The  accounting  suggestions  were 


« 


HEALTH  BUDGET,   NEW  YORK  CITY 

made  in  general  terms  only  but  contemplated  several 
important  changes: 

(i)  The  basing  of  expense  accounts  upon  a  record 
of  requisitions  for  supplies,  instead  of  upon  vouchers 
for  payment. 

(2)  The  keeping  of  stock  ledgers,  one  side  of  which 
should  show  charges  against  the  store-keeper,  the  ac- 
curacy of  which  should  be  controlled  from  a  record 
of  vouchers;  the  other  side  of  the  stock  ledger  to  give 
stock  distribution  and  to  be  controlled  through  store- 
keepers' reports,  showing  in  detail  how  each  class  of 
stock  was  distributed  to  departments  or  divisions.  To 
prove  their  reports  of  goods  distributed,  store-keepers 
would  have  copies  of  requisitions;  to  prove  the  balance 
'''in  stock,"  they  would  have  the  results  of  an  inventory 
of  stock  on  hand.  Entires  from  the  store-keepers'  reports 
to  be  posted  to  the  several  expense  accounts  affected  by 
the  distribution. 

(3)  The  use  of  a  classified  pay-roll  supported  by  time 
sheets,  on  which  would  be  noted  the  departments  or 
divisions  of  work  on  which  the  employee  was  engaged, 
the  time  sheet  being  a  basis.  Just  as  the  store-keepers' 
reports  would  show  goods  actually  consumed  by  an  ac- 
tivity, so  the  time  sheet  would  show  time  actually  given 
by  an  employee  to  each  activity.  As  the  store-keepers' 
reports  show  supply  cost,  the  time  sheet  would  show 
the  wage  cost.  The  two  combined  would  give,  when 
verified  by  comparison  with  records  of  requisitions,  stock 
ledgers  and  appropriation  ledgers,  a  complete  classified 
controlled  expense  record  of  each  activity  for  the  period 
reported  on. 

In  defense  of  these  suggestions  it  is  worth  while  here 
to  emphasize  one  or  two  propositions  that  have  become 
axiomatic  in  the  book-keeping  of  private  enterprises: 
to  segregate  accounts  does  not  increase  the  number  of 
items  to  be  posted ;  it  is  just  as  easy  to  post  a  charge  or 
credit  of  $25.00  for  "horse  hire"  to  a  page  headed 
"horse  hire"  as  to  a  page  headed  "miscellaneous." 
The  difference  between  high ,  segregation  and  low 
segregation  is  not  that  the  former  requires  larger  outlay 
for  clerical  service,  but  that  it  actually  decreases  the 
difficulty  of  re-casting  and  recapitulating  items  necessary 


29 


Cost  Means 

Goods  Used 

Not 

Goods  Bought 


Time  Sheets 
To  Show 
Wage   Cost 


Advantage 

of 
High  Segregation 

Over 
Low  Segregation 


I      I 

i 


30 


Items 
Segregated 


MAKING  A  MUNICIPAL  BUDGET 

in  order  to  find  out  what  has  been  posted  in  a  ledger. 
Once  installed,  high  segregation  designed  to  answer  sig- 
nificant questions  would  save  a  great  deal  of  confusion 
and  clerical  labor,  and  would  also  show,  where  if  at  all,, 
economies  can  be  effected  and  efficiency  increased. 

Expedient  Suj!:s;ested  for  Classification  of  Budget 

Estimates 

To  the  end  that  the  department's  budget  might  be 
classified  according  to  the  several  functions  and  activities 
maintained,  and  as  a  means  of  enabling  the  department 
to  draw  off  the  information  needed  to  support  a  budget 
so  classified  without  further  recapitulation,  it  was  pro- 
posed that  the  segregation  ledger  be  at  once  modified 
to  serve  this  purpose.  As  a  result  of  conferences  between 
the  Bureau,  the  health  department  and  the  finance  de- 
partment, a  new  segregation  ledger  was  installed. 
(Exhibit  5.)  This  new  record,  however,  is  still  defec- 
tive in  two  particulars: 

(i)  It  lacks  direct  accounting  control. 

(2)  It  is  only  a  record  of  expenditures  and  not  a 
record  of  cost  of  operation. 

Further  work  in  the  improvement  of  the  system  of 
accounts  has  been  temporarily  postponed,  pending  action 
by  the  joint  committee  of  the  Bureau  and  the  department 
of  finance,  which  has  under  consideration  a  complete 
plan  of  organization  of  the  departmental  accounts  of  the 
city. 

Conclusion 

It  is  not  suggested  that  the  work  described  in  the 
foregoing  pages  has  arrived  at  completion.  On  the  con- 
trary, it  is  seen  by  the  principal  officers  of  the  depart- 
ment of  health  and  by  the  department  of  finance,  as 
well  as  by  the  Bureau  of  Municipal  Research,  that  many 
further  steps  are  necessary  to  the  efficient  operation  of 
principles  already  embodied  in  the  forms  of  account, 
record  and  budget  herewith  submitted. 

A  system  of  service  records,  no  matter  how  carefully 
constructed,  will  inevitably  encounter  in  actual  operation 
many  difficulties  not  foreseen  at  the  outset ;  a  department 
that  covers  five  boroughs  and  maintains  a  great  variety 
of  activities,  can  not  change  its  ways  in  a  day,  because 


»       4 


:> 


I 


HEALTH  BUDGET,   NEW  YORK  CITY 

the  work  of  the  department  is  constantly  developing 
records  which  reflect  that  work  must  also  progressively 
develop.  How  adequate  records,  promptly  and  properly 
studied,  lead  to  improvements  in  work,  to  changes  of 
method  and  to  corresponding  changes  of  records  and 
accounts,  is  illustrated  by  a  "merger,"  now  under  consid- 
eration by  the  department,  of  district  inspection  of  con- 
tagious diseases  with  medical  inspection  of  schools. 
The  discussion  of  the  plan  is  based  entirely  on  a  care- 
ful study  of  the  daily  records  employed  during  the  later 
months  of  the  school  year  ending  June  30th,  1907.  The 
health  budget  for  1907  recognized  the  distinction  between 
the  division  of  contagious  diseases  and  the  division  of 
medical  inspection  of  schools;  each  division  has  its  own 
separate  pay-roll;  the  school  physician  did  not  go  into 
homes  to  inspect  contagious  diseases;  there  was,  there- 
fore, no  overlapping  of  work  done,  although  there  was 
an  overlapping  of  territory  traversed.  To  see  whether 
time  spent  by  inspectors  on  the  street  might  be  reduced, 
the  following  experiment  was  made  in  a  small  number 
of  representative  districts : 

The  school  inspector  was  asked  to  take  charge  of  both 
the  school  work  and  the  contagious  disease  work  of  his 
small  district,  going  to  the  schools  first,  and  making  a 
house  to  house  inspection  after  leaving  the  school.  Only 
one  physician  worked  in  one  territory ;  this  physician  at- 
tended to  all  of  the  requirements  of  his  district,  included 
under  the  two  headings,  contagious  diseases  and  school 
inspection.  When  the  records  of  this  plan  were  com- 
pared with  the  records  of  the  prevailing  plan  (two  men 
working  in  the  same  territory  on  different  work)  the 
following  advantages  stood  out  clearly  in  favor  of  merg- 
ing the  t^vo  functions  in  one  man  for  a  district  fitted  to 
the  amount  of  work  required :  (i)  Less  time  was  lost  on 
the  street  in  going  from  inspection  to  inspection;  (2) 
Consequently  more  hours  were  given  to  inspection ;  (3) 
Responsibility  for  a  district  led  to  more  efficient  ser- 
vice in  each  division :  (4)  Concentration  of  responsibility 
in  one  man  led  principals,  parents,  family  physicians, 
hospitals  and  dispensaries  to  co-operate  more  readily  and 
more  effectively,  in  securing  necessary  treatment  for 
school  children  and  in  checking  contagion.    The  depart- 


31 


Progress 

Means 

Chang<e 

of 
Records 


Illustration 


32 


Progress 

Means 

Change 

of 
Accounts 


Control 

Provided 

Should 

be 
Exercised 


Illustration 


MAKING  A  MUNICIPAL  BUDGET 

ment  has  therefore  decided  to  ask  that  its  budget  for 
1908  make  no  distinction  between  the  two  divisions  men- 
tioned, but  that  it  estabhsh  a  new  division:  School 
and  District  Inspection.  By  giving  to  this  merger  of  two 
divisions  the  funds  given  in  the  budget  of  1907  to  both 
divisions,  it  is  estimated  that  the  department  could  ac- 
compHsh  50%  more  work. 

The  foregoing  illustration  serves  to  show  also  how 
budget  recommendations,  as  well  as  those  bearing 
upon  reports  and  accounts,  will  need  modification  after 
being  tested.  Whenever  the  budget  is  changed,  ledgers 
and  all  controlling  accounts  will  generally  need  some 
modification,  as  well  as  reports  that  record  results  of 
supervising  and  district  inspectors. 

After  the  accounting  records  of  the  department  have 
been  reduced  to  control  by  the  methods  outlined  on  page 
29  it  will  still  be  necessary  to  see  that  the  control  is 
exercised.  As  evidence  of  the  danger  that  controlling 
records  shall  not  be  used  for  control  may  be  cited  the 
experience  the  department  is  now  undergoing,  in  Aug- 
ust, 1907,  when  no  funds  are  at  hand  for  paying  em- 
ployees of  the  bacteriological  division.  Accounts  already 
installed  show  clearly  to  the  commissioner,  the  board  of 
health  and  the  comptroller,  not  only  that  funds  are  lack- 
ing to  meet  this  particular  pay-roll,  but  also  that  the  charg- 
ing of  the  amount  on  this  pay-roll  to  any  other  pay-roll 
is  in  direct  violation  of  the  principle  of  the  segregated 
budget.  There  has  been  a  great  deal  of  discussion  as  to 
the  steps  that  should  be  taken:  Shall  men  working  in 
the  bacteriological  laboratory  be  put  on  the  school  in- 
spection pay-roll  because  that  fund  happens  to  have  a 
surplus?  If  this  change  is  made  shall  the  department 
try  to  get  it  through  the  comptroller's  office  without  the 
latter  knowing  of  the  mischarge?  Shall  it  candidly  put 
itself  on  record  as  passing  this  mischarge  and  submit  an 
explanatory  note  with  this  pay-roll?  Shall  the  comp- 
troller's office  wink  at  the  mischarge  and  honor  it  after 
recording  on  the  pay-roll  the  fact  as  to  want  of  funds, 
thus  admitting  the  unauthorized  character  of  the  trans- 
action? Or,  shall  it  notify  the  health  department  in 
advance  to  "hew  to  the  line"  of  its  instructions  from  the 
board  of  estimate  and  apportionment  when  the  budget 


HEALTH  BUDGET,  NEW  YORK  CITY 

for  this  year  was  voted  and  simply  withhold  the  pay-roll 
until  funds  are  provided  at  the  September  meeting  of  the 
fiscal  authorities?  The  latter  course  has  been  adopted. 
The  principle  of  the  segregated  budget  is  thus  re-affirmed 
by  both  the  comptroller  and  the  department  of  health. 
While  still  experimental,  the  forms  for  account,  record 
and  budget  of  the  department  of  health  now  in  force 
are  sufficiently  definite  to  show  clearly  how  far  the 
health  department  is  discharging  its  obligations  and 
using  its  opportunities,  and  where,  if  at  all,  methods  of 
administration  need  to  be  changed. 


33 


Defects 
Will  Be 
Shown 
CuiTently 


1 ' 


34 


Exhibit   I 


ANALYSIS  OF  THE  SALARY  EXPENDITURE  OF  THE  DEPARTMENT 
OF  HEALTH  OF  THE  CITY  OF  NEW  YORK  FOR  THE  YEAR 

1906 

Presented  to  the  Board  of  Estimate  and  Apportionment  by  the  Bureau  of  City 
Betterment  of  the  Citizens'  Union,  October  12,  1906,  for  consideration  in 
connection  with  the  estimate  of  expenditure  submitted  to  the  De- 
partment of  Health  of  the  City  of  New  York  for  the  fiscal  year 


1907 


New  York,  October  12,  1906. 


To  the  Honorable,  the  Chairman  and  Members  of  the  Board  of  Estimate  and 
Apportionment  of  the  City  of  New  York. 

Gentlemen: 

At  present  there  are  thirteen  appropriation  accounts  in  the  budget  of  the 
department  of  health.  Your  Honorable  Board  has  in  the  past  granted  money 
to  this  department  for  eleven  general  purposes.  There  are,  however,  forty-nine 
functional  divisions  of  the  department,  including  all  the  boroughs.  Nine  of 
these  are  divisions  of  general  administration,  forty  are  divisions  of  work.  Each 
of  these  forty  divisions  has  its  special  work  to  do.  The  thoroughness  and  extent 
of  the  work  of  each  division  determines  the  health  condition  of  the  city  as  a 
whole. 

How  much  sickness  the  department  of  health  will  prevent  next  year  and 
how  many  lives  it  will  save  depends  very  largely  upon  the  amount  of  money  you 
grant  that  department.  The  department  of  health  is  striving  towards  a  com- 
plete control  of  the  health  of  the  city — towards  the  complete  prevention  of 
preventable  diseases  and  preventable  death.  How  nearly  this  end  is  to  be  reached 
in  1907  is  a  question  of  dollars  and  cents.  Briefly,  it  is  a  question  of  how  much 
health  the  city  can  afford  to  buy. 

In  deciding  how  much  health  the  city  can  buy  it  is  necessary  to  decide 
how  the  buying  shall  be  done.  To  make  an  allowance  for  the  health  needs  of 
the  city,  you  now  (or  later,  the  board  of  health),  must  determine  how  much 
health  shall  be  bought  through  the  treatment  and  prevention  of  tuberculosis, 
through  the  disinfection  of  infected  houses,  through  hospitals,  through  an  im- 
proved milk  supply,  how  much  through  an  improved  physical  condition  of  the 
children  in  the  schools,  and  so  on. 

The  lowering  in  the  death  rate  per  thousand  of  the  population  from  20.57 
in  1900  to  18.32  in  1905  is  evidence  of  the  effective  work  of  your  health  officials. 
This  reduction  means  the  saving,  in  one  year,  in  a  city  of  4,000,000  population,  of 
9,000  lives.  This  saving  of  life  is  a  vast  achievement,  but  it  does  not  represent 
all  that  the  department  might  do.  The  fact  that  27,670  persons  died  from  pre- 
ventable dfseases  in  1905  is  in  part  an  index  of  work  undone.  Not  only  might  the 
27,670  lives  have  been  saved  if  the  sanitation  of  the  city  had  been  perfect,  but 
untold  sickness  with  its  accompanying  misery  and  heavy  financial  cost  might 
have  been  avoided,  as  well.  How  important  it  is  to  prevent  illness  is  strongly 
shown  by  the  great  annual  registration  in  the  ranks  of  tuberculosis.  In  1905 
there  were  more  than  20,000  new  cases  of  tuberculosis  reported. 

If  we  are  correct  in  assuming  that  the  amount  of  health  the  city  may  enjoy 
can  be  measured  in  terms  of  dollars,  we  submit  that  your  Honorable  Board  is 
primarily  responsible  for  the  health  of  the  city — responsible  for  the  lives  lost 
through  preventable  diseases,  responsible  for  sickness  unnecessarily  incurred. 
We  ask  that  your  allowance  to  the  department  of  health  on  the  basis  of  the 
work  you  expect  it  to  do  in  its  several  divisions.  For  example,  we  ask  you  in 
granting  funds  for  medical  school  inspection  to  determine  how  closely  the  health 
of  the  children  in  the  schools  of  the  city  shall  be  guarded — how  many  abnormal 
and  backward  children  shall  be  returned  to  health  of  body  and  mind  by  the  cure 


•n 


t 


Exhibit  I— Continued 


35 


of  wholly  curable  defects.  We  ask  you  to  determine  how  many  children  shall  be 
saved  from  suffering  the  handicap  of  one  of  the  many  contagious  diseases  which 
afflict  the  children  of  the  city.  We  ask  you  to  know  exactly  what  has  been  done 
in  the  field  of  medical  inspection  of  school  children  in  this  year,  what  its  cost 
has  been  and  what  its  results.  We  ask  you  to  look  carefully  into  the  field  of 
milk  inspection  to  determine  what  it  has  cost  this  year  to  save  thousands  of 
babies  from  death  by  giving  them  pure  milk,  and  then  to  determine  exactly  how 
many  babies  you  can  afford  to  save  next  year,  and  how  many  babies  to  save 
from  sickness.  Similarly,  we  ask  that  you  demand  information  respecting  the 
work  of  the  department  in  every  division  for  which  an  appropriation  is  needed. 

We  have  during  the  past  several  weeks,  with  the  permission  of  the  com- 
missioner of  health,  made  a  classification  of  the  pay-roll  expenditure  of  the 
department  of  health  for  1906.  This  classification  is  made  on  the  basis  of  the 
divisions  of  work  that  exist  in  the  organization  of  the  department.  We  have 
accounted  for  every  man  in  the  department  pay-roll  and  charged  his  salary  or 
wages  to  the  division  or  divisions  in  which  he  was  employed  during  the  year. 
We  beg  leave  to  present  the  results  of  this  classification  for  your  consideration 
and,  we  hope,  for  your  use  in  making  up  the  health  budget.  It  will  show  the 
pay-roll  cost  of  carrying  on  the  various  activities  of  the  department,  grouped  by 
divisions. 

It  has  seemed  unwise  to  include  the  data  we  have  secured  respecting  the 
distribution  of  supplies  and  contingencies.  A  classification  of  supply  expenditure 
should,  of  course,  be  included  in  the  detailed  statement  to  show  the  total  cost 
of  operation  in  the  respective  divisions.  It  is  practically  impossible,  however, 
at  this  time,  to  satisfactorily  forecast  the  distribution  of  the  supply  expenditure 
for  the  remainder  of  the  year.  We  ask  that,  in  the  future,  the  department  show, 
in  its  annual  estimate,  the  distribution  of  supply  and  contingencies  expenditure 
by  divisions.  It  is  suggested  that  these  supply  appropriations  might  be  allowed 
under  general  titles  for  1907,  as  they  have  been  in  the  past. 

The  following  statement  is  submitted  with  the  thought  that  by  contrasting 
the  facts  there  shown  with  the  results  achieved  by  the  department  you  may  be 
guided  in  determining  the  proper  allowances  in  1907  for  the  several  divisions  of 
the  department  work.  We  believe  that  in  this  way  you  may  assume  a  control 
proper  to  the  function  of  your  Honorable  Board  over  the  expenditure  and  activi- 
ties of  this  department. 

We  suggest  that  the  department  of  health  be  provided  with  funds  to  carry 
out  the  work  of  its  several  divisions  as  fully  as  the  city  can  afford.  We  assume 
that  no  one  will  question  that  as  much  shall  be  spent  on  the  health  of  the  city 
in  1907  as  will  be  spent  this  year.  The  expenditure  of  the  department  in  1906, 
exclusive  of  corporate  stock,  but  including  $537,53750  of  revenue  bonds  and 
$100,000  in  receipts,  will  reach  a  total  of  approximately  $2,000,000.  In  1907  the 
department  will  carry  on  certain  new  activities  and  these  will  require  additional 
funds. 

Respectfully  submitted 

BUREAU  OF  CITY  BETTERMENT. 

Citizens'  Union  of  the  City  of  New  York, 
t_  By  Henry  Bruere,  Secretary 


-36 


Exhibit  2  Ko) 


RESOLUTION  OF  THE  BOARD   OF   ALDERMEN   IN  FAVOR 

OF  A  CLASSIFIED  BUDGET 

Whereas,  During  several  years  past,  and  especially  during  this  present 
year,  the  heads  of  the  departments  of  this  city  have  felt  compelled  to  request 
the  issuance  of  very  large  amounts  of  special  revenue  bonds  in  order  to  meet 
their  department's  ordinary  running  expenses,  explaining  that  the  depart- 
ment's budget  allowances  had  been  greatly  under  the  estimate  submitted,  and 
that  the  allowance  had  been  so  general  and  unitemized  that  the  commissioner 
could  not  know  what  reductions  were  intended,  and  was  not  able  to  make  a 
substantial  and  intelligent  reduction;  and 

Whereas,  This  board  believes  that  the  public  interest  is  opposed  to  the 
issuance  of  these  bonds  except  for  emergencies ;  and 

Whereas,  The  1907  budget  is  now  in  course  of  preparation  by  the  board 
of  estimate  and  apportionment  to  be  later  submitted  to  this  board;  therefore, 
be  it 

Resolved,  That  the  board  of  aldermen  respectfully  recommends  to  the 
board  of  estimate  and  apportionment,  that  in  the  preparation  of  the  budget 
for  1907,  instead  of  following  the  usual  course  of  making  general  and  unitem- 
ized allowances  to  the  general  accounts  of  the  various  departments,  that  the 
budget  do  allow  specific  appropriation,  indicating  which  estimates  are 
granted  and  which  are  denied,  in  the  case  of  every  item  in  every  account  as 
they  appear  in  the  departmental  estimate  and  that  the  expenditure  of  each 
allowance  be  confined  to  the  purposes  as  so  indicated,  and  to  provide  as  far 
as  possible,  that  no  transfers  be  made,  even  for  different  items  in  the  same 
account,  without  the  authorization  of  the  board  of  estimate  and  apportion- 
ment. 

Adopted  by  the  board  of  aldermen  October  9,  1906,  a  majority  of  all 
the  members  elected  voting  in  favor  thereof. 


October  9,  1906. 


P.  J.  SCULLY,  Clerk. 


^ 


Exhibit  2  (3) 


n 


\ 


% 


RESOLUTION  OF  THE  BOARD  OF  ESTIMATE  AND   APPOR- 
TIONMENT  IN  FAVOR  OF  A  CLASSIFIED  BUDGET 

Whereas,  The  board  of  estimate  and  apportionment  has  received  cer- 
tain preamble  and  resolutions  adopted  by  the  board  of  aldermen,  October 
9,  1906,  requesting  "that  the  budget  do  allow  specific  appropriations,  indi- 
cating which  estimates  are  granted  and  which  are  denied,  in  the  case  of 
every  item  in  every  account  as  they  appear  in  the  department  estimate,  and 
that  the  expenditure  of  each  allowance  be  confined  to  the  purposes  as  so 
indicated,"  etc. ;  and 

Whereas,  Time  has  not  permitted  the  adoption  of  this  plan  in  more 
than  a  small  part  of  the  budget  for  1907 ;  be  it,  therefore 

Resolved,  That  it  is  the  opinion  of  the  board  of  estimate  and  appor- 
tionment that  the  budget  of  The  City  of  New  York  for  the  year  1908  should 
contain,  whenever  possible,  a  specific  item  for  each  class  of  expenditure 
to  be  made  thereunder  in  order  that  through  said  budget  adequate  control 
may  be  had  over  the  administrative  and  other  cost  of  the  various  city  and  other 
departments,  especially  to  prevent  increases  in  salary  expenditures  by  de- 
partment heads  within  the  budget  allowances  of  said  departments  for  the 
year  but  in  excess  of  the  annual  rates  of  salary  allowances  upon  which 
the  budget  was  granted,  and  for  the  purpose  of  carrying  out  this  plan 
the  comptroller  is  hereby  requested  to  direct  the  preparation,  by  the  bureau 
of  municipal  investigation  and  statistics,  of  the  finance  department,  and 
submit  to  the  board  of  estimate  and  apportionment,  not  later  than  May 
I,  1907,  an  outline  plan  for  the  departmental  estimate  for  each  one  of  the 
departments  and  county  and  other  offices  of  the  city  to  which  allowances 
will  be  made  in  the  budget  for  1908,  said  plan  to  provide  for  compliance 
with  the  purpose  of  this  resolution  in  the  said  Budget  of  1908. 

Which  was  adopted  by  the  following  vote : 

Affirmative— The  mayor,  the  comptroller,  the  president  of  the  board 
of  aldermen  and  the  presidents  of  the  boroughs  of  Manhattan,  Brooklyn 
and   Queens — 14. 

October  30,  1906 


tl 


38 


Exhibit  J 


TITLES  FOR  BUDGET  APPROPRIATION,  DEPARTMENT  OF 
HEALTH:  (A)  UNSEGREGATED  BUDGET  1906.  (ii).  (B)  SEGREGA- 
TION OF  PAYROLL  PROPOSED  BY  THE  BUREAU  FOR  1907,  (34).  (C) 
VOTED  BY  THE  BOARD  OF  ESTIMATE  AND  APPORTIONMENT  FOR 
THE  BUDGET  OF  1907.  (29).  (D)  ADOPTED  BY  THE  CONFERENCE  COM- 
MITTEE OF  THE  FINANCE  DEPARTMENT  AND  THE  BUREAU.  AND 
PRESCRIBED  BY  THE  COMPTROLLER  FOR  THE  BUDGET  OF  1908 
("3). 

Within  the  limits  of  the  functions  included  in  titles  given,  the  board  of 
health  may  spend  its  appropriation  as  it  wishes.  But  neither  the  board  of  health 
nor  any  other  department  or  city  official  has  authority  to  divert  funds  voted 
under  one  title  to  purposes  included  in  another  title.  If  a  function  must  be  crip- 
pled, or  if  a  surplus  is  to  be  transferred,  the  board  of  estimate  and  board  of 
aldermen  must  assume  responsibility. 


F 


I 


(A) 


UNSEGREGATED  BUDGET,  1906 

(11  titles) 


Salaries,  Board  of  Health  and  Executive  Officers 

Salaries  of  Officers,  Clerks,  Inspectors  and  Other  Employees 

Salaries,  Medical  School  Inspection 

Salaries,  Bacteriological  Laboratory 

Removal  of  Night  Soil,  Offal  and  Dead  Animals 

Sanitary  Police 

Supplies  and  Contingencies 

Disinfection 

Hospital  Fund 

Support  of  Ambulance  Service 

For  Abatement  of  Nuisances 

(B)    SEGREGATION    OF    PAY-ROLL    PROPOSED    BY    THE    BUREAU 

FOR  1907 

(34  titles  ) 

Commissioner's  Office 
Secretary  of  Board  of  Health,  Office 
General  Medical  Officer,  Office 
Chief  Clerk's  Office 
Sanitary  Superintendent's  Office 
Superintendent  of  Hospitals 
Corporation  Counsel's  Office 
Registrar  of  Records 
Communicable  Diseases,  Office 
Assistant  Chief  Clerks 
Executive  Division:   Office  Force 
Division  of  Inspections:    Office  Force 

"  "  Inspection  Force 

Division  of  Contagious  Diseases:    Office  Force 

Medical  Inspection 

Relief  Work 

Preventive  Work 
Division  of  Communicable  Diseases:    Office  Force 

Inspection  Force 


i    « 


(( 


tt 


u 


u 


u 


« 


II 


Assistant  Registrars  of  Records 

Research  Laboratory 

Vaccine 

Chemical 

Diagnosis 


Nurses 


« 


It 


it 


Exhifnt  s— Continued  19 

Willard  Parker  and  Reception 

Trachoma 

Kingston  Avenue 

Riverside  — 

Tuberculosis  Clinic  , , 

Otisville 

Building  Fund 

Re-indexing  Records 

Medical  Commissions 

(C)    VOTED  BY  THE  BOARD  OF  ESTIMATE  AND  APPORTIONMENT 

FOR  THE  BUDGET  OF  1907 


I. 
2. 

3. 

4. 
5. 
6. 

7. 
8. 

9. 
10. 
II. 
12. 

13. 
14- 

1$. 
16. 

17. 
18. 

19. 
ao. 
21. 
22. 
23. 
24. 
as. 
26. 

27. 
28. 
29. 


« 


II 
II 


II 


M 


II 


(29  titles  ) 
Executive  Office 
Assistant  Chief  Clerks 

Executive  Division 

Sanitary  Police 

Inspections 

Contagious  Diseases,  Office 

"  "         Medical  Inspection 

•*  "         Relief  Work 

"  Preventive  Work 

Communicable  Diseases 
Assistant  Registrars  of  Records 
Research  Laboratory 
Vaccine  Laboratory 
Diagnosis  Laboratory 
Chemical  Laboratory 
William  Parker  and  Reception  Hospitals 
Trachoma  Hospital 
Riverside  Hospital 
Tuberculosis  Clinic 
Kingston  Avenue  Hospital 
Otisville  Sanatorium 
Supplies  and  Contingencies 
Removal  of  Night  Soil 
Disinfection 
Hospital  Fund 
Ambulance  Service 
Laboratory  Fund  (New) 
Abatement  of  Nuisances 
Tuberculosis  Fund  (New) 


40 


(D) 


Exhibit  s^Continutd 

ADOPTED  BY  THE  CONFERENCE  COMMITTEE  OF  THE  FINANCE 
DEPARTMENT  AND  THE  BUREAU,  AND  PRESCRIBED  BY 
THE  COMPTROLLER  FOR  THE  BUDGET  OF  1908 

(123  titles) 


i1       % 


Exhibit  s^Continued 


II.  BOROUGH  ADMINISTRATION  OF  SANITA- 
TION  AND  PREVENTION  OF  CONTAGIOUS 
DISEASES-continued 


41 


m 


1.    GENERAL  ADMINISTRATION 
Salaribs 

Office  of  the  commissioner 

secretary 

chief  clerk 

registrar  of  records 

sreneral  medical  officer   .  .  .  . 

sanitary  supt 

supt.  of  hospitals 

law  clerk 

'\    "    inspector  of  construction  and 
repairs 

Maintenance  (i.  e.,  renewals;  renewal  supplies 
and  repairs) 

Equipment  (i.  e.,  furniture,  vehicles,  imple- 
ments, etc.) 

Supplies  (i.  e.,  consumable  supplies,  such  as 
medicines;  foods;  parts  of  animals  used 
for  laboratory  and  other  medical  purposes  • 
forage,  etc.) 

Contingencies 

Telephone  (one  appropriation  for  each  borough) 

Rents  (These  are  provided  for  by  the  sinking 
fund  commissioners  but  should  be  shown  as 
separate  items  in  this  budget) 

II.  BOROUGH  ADMINISTRATION  OF  SANITA- 
TION AND  PREVENTION  OF  CONTAGIOUS 
DISEASES 

Manhattan 
Salaries 

Office  of  assistant  sanitary  superintendent  . 

"  assistant  chief  clerk 

"  assistant  registrar  of  records  .... 

Division  of  inspections 

(a)  Sanitary  inspection,  i.  e.,  special  in- 
si)ection,  district  inspection,  mercantile 
house  inspection,  lodging-house  in- 
spection    

(*)    Food,  fruit,  meat  and  fish  inspection  . . 

(c)    Milk  inspection— (all  Boroughs)  .... 

Division  of  contagious  diseases 

Division  of  school  medical  inspection 

Sanitary  police 

Maintenance 

Equipment 

Supplies 

Contingencies 


I 
I 
$ 
I 
S 
I 
S 
I 

$_ 

I 

I 


The  Bronx 
Salaries 

Office  of  assistant  sanitary  superintendent . 

assistant  chief  clerk 

"  assistant  registrar  of  records  . .  .  . 
Division  of  inspections 

(a)  Sanitary  inspection,  i.  e.,  special  in- 
spection, district  inspection,  mercantile 
house  inspection,  lodging-house  in 
spection 

{b)    Food,  fruit,  meat  and  fish  inspection  .  . 

Division  of  contagious  diseases 

Division  of  school  medical  inspection 

Sanitary  police 

Maintenance 

Equipment 

Supplies 

Contingencies 


Brooklyn 
Salaries 

Office  of  assistant  sanitary  superintendent . 

chief  clerk 

registrar  of  records  .   .   . 
Division  of  inspections 

(a)  Sanitary  inspection,  i.  e.,  special  in- 
spection, district  inspection,  mercantile 
house  inspection,  lodging-house  inspec- 
tion     

(b)  Food,  fruit,  meat  and  fish  inspection.  . 

Division  of  contagions  diseases 

Division  of  school  medical  inspection 

Sanitary  j>olice 

Maintenance 

Equipment 

Supplies 

CoBtingenciet 


% 
I 
I 


$ 
I 


I 
I 


42 


Exhibit  j^Coniinued 


II    BOROUGH  ADMINISTRATION  OP  SANITA- 
TION AND  PREVENTION  OF  CONTAGIOUS 
DISEASES— Continued 

Queens 

Salaries 

Office  of  assistant  sanitary  superintendent  • 

S 

chief  clerk 

s 

"       "          registrar  of  records. .  .  . 

1 

Division  of  inspections 

(a)    Sanitary  inspection,   i.  e.,  special   in- 
spection, district  inspection,  mercantile 
house  inspection,  lod8:in8:-house  inspec- 
tion   

(b)    Pood,  fruit,  meat  aud  fish  inspection  . 

Division  of  conta&ious  diseases 

Division  of  school  medical  inspection 

1 
s 

Sanitarv  Dolice 

Maintenance 

Bauioment 

SuDolies 

Contingencies 

1 

s 

Richmond 

Sala&ies 

Office  of  assistant  sanitary  superintendent .  .  . 

1 

chief  clerk 

1 

1 

"        registrar  of  records 

Division  of  inspections 

(a)    Sanitary  inspection,  i.  e.,  special   in- 
spection, district  inspection,  mercantile 
house  inspection,  lodging-house  inspec- 
tion  

s 
1 

♦ 

(b)    Food,  fruit,  meat  and  fish  inspection  .  . 

Division  of  contagious  diseases 

1 

Division  of  school  medical  inspection  .  . 

1 

1 
1 

Sanitary  oolice 

Maintenance 

s 

Equipment 

1 

1 

Supplies 

Contingencies 

1 

1 

t1  i< 


I 


} 


Exhibit  s — Continued 


III.  DIVISION  OF  COMMUNICABLE  DISEASES 
Salaries 

District    inspection,     medical    inspection, 
tuberculosis  nurses 

Manhattan 

The  Bronx 

Brooklyn 

Queens 

Richmond 

Clinics  for  treatment  of  communicable  pul- 
monary diseases,  attending  physicians 
and  nurses 

(One  appropriation  for  each  borough) 

Diagnosis  laboratory;  bacteriologists;  col- 
lection, preparation  and  examination  of 
specimens — Manhattan  only 

Maintenance 

Equipment 

Supplies 

Contingencies 

IV.  LABORATORIES 

Research  laboratory 

Vaccine  "  

Chemical        "  

Drug  *•  

Maintenance 

Equipment 

Supplies 

Contingencies 

(Separate  expense  appropriations  for 
each  laboratory) 


V.    HOSPITALS 
Riverside 
Salaries  .... 
Maintenance  . 
Equipment . . 
Supplies  .... 
Contingencies 


$ 
$ 
S 
$ 

s 


i_ 

$ 
% 
% 
% 


% 
% 
% 
% 


[' 


43 


44 


Exhibit  s— Continued 


V.    HOSPITALS— continued 

WlLLARD  PAmKEX  AlfX>  RXCBPTIOK 

Salaries 

Maintenance 

Equipment *. 

Supplies 

Contmsenciet 


Kingston  Avbnxtb 

Salaries 

Maintenance 

Equipment 

Supplies 

Contingencies  .... 


Trachoma 
Salaries    .  .  , 
Maintenance  . 
Equipment  .  . 
Supplies  .  .   . 


J     < 


Exhibit  J — Continued 


4S 


^.uuiiu^cucies 

% 

Otisville 
Salaries 

t 
% 
$ 

$ 
$ 
$ 

i 

Maintenance 

Equipment 

Supplies 



Continsrencies 

VI.    MISCEI.LANEOUS 

(a)    Removal  of  night  soil 

(*)    Support  of  private  ambulance 
{c)    Abatement  of  nuisances  .... 

service  .  .  . 

r 


(a)    One  appropriation  for  each  borough 

id)    One  appropriation  for  Brooklyn  and  an  appropriation  for  Queens 

{c)    One  appropriation  for  each  borough 


Notes  in  Re  Department  of  Health  Budgfet  for  J908 

SCHEDULE — Showing  specifically  the  expenditures  which  will  classi- 
fy under  the  general  groupings  respectively  of  ''Main- 
tenance,"  "Equipment,"  "Supplies"  and  "Contingen- 
cies" to  wit: 

MAINTENANCE : 

Automobile  Storage;  Horseshoeing  and  Clipping;  Livery; 
Care  and  Maintenance — Department  Buildings;  Repairs — 
Department  Buildings;  Repairs  and  Improvements  to 
Grounds  and  Buildings  only. 

EQUIPMENT : 

Furniture  and  Repairs  to  Furniture;  Automobile  Purchase 
and  Repairs;  Carriage  Purchase  and  Repairs;  Harness 
Purchase  and  Repairs;  Horse  Purchase  and  Hire;  Stable 
Fixtures  and  Repairs;  Disinfecting  Fixtures  and  Repairs; 
Instruments  and  Apparatus ;  Purchase  of  Cows. 

SUPPLIES : 

Books,  Periodicals,  etc. ;  Miscellaneous  Supplies ;  Automobile 
Fuel  and  Supplies;  Horse  Feed;  Stable  Supplies;  Standard 
Samples;  Peppermint  Oil  and  Uranine;  Disinfectants; 
Disinfectors'  Supplies ;  Foods ;  Drugs  and  Chemicals ;  Drug- 
gists' Sundries;  Fuel;  Light;  Clothing,  Boots  and  Shoes; 
Dry  Goods;  Bedding;  Notions;  Crockery  and  House  Fur- 
nishings; Freight  and  Express;  Farmers'  Supplies;  Engi- 
neers' Supplies ;  Carpenters',  Gardeners',  and  Painters'  Sup- 
plies ;  Ice ;  Blood ;  Hire  of  Calves ;  Milk  for  Vaccine  Virus ; 
Needles,  Boxes,  etc.;  Care  and  Maintenance  and  Medical 
Attendance  of  Horses;  Purchase  of  small  Animals;  Feed 
for  small  Animals ;  Boxes,  Vials,  and  Syringes. 

CONTINGENCIES : 

Traveling  Expenses;  Carfares,  Expressage,  etc.;  Automo- 
bile Hire ;  Postage,  etc.  Traveling  Expenses— Milk  Inspec- 
tors; Disinfectors'  Carfares. 


46 


47 


I       < 


Exhibit  4 

Tabular  forms  devised  by  the  Bureau  of  Municipal  Research  and  adopted 

by  the  department  of  health  for  use  in  the  latter's  annual  report 

to    show    the  work  done  and  results  obtained  in  the 

various  lines  of   activity    maintained    by    the 

department ;  with  notes  as  to  methods^ 

purposes  and  interpretation 


t       % 


INDEX 

DIVISION   OF   INSPECTIONS 

GENERAL  SANITARY  INSPECTION 

Table    i    Nature  of  Complaints  and  Action  Taken,  1906 
Table    2    Complaints  Disposed  of  within  30  and  60  Days,  1906 
Table    3    Complaints  Pending  Dec.  31,  1906,  and  When  Received 
Table    4    Premises  Ordered  Vacated,  1906 

MILK  INSPECTION 

Table  5  Comparative  Summary  of  Infant  Death  Rate,  Bacterial  Content  of  Milk 
Samples,  and  City  Inspection,  1902-1906 

Table  6  Deaths  and  Death  Rate  of  Children  under  i  Year  of  Age  from  Diarrheal 
Diseases  during  the  months  of  June,  July,  August,  and  September, 
1902-1906 

Table    7  Bacterial  Content  of  Milk  Samples,  1902-1906 

Table    8  Milk  Inspection  within  New  York  City,  1906 

Table    9  Creamery  Register,  1906 

Table  10  Creamery  Scores,  All  Creameries  Registered,  1906 

Table  11  Creamery  Scores,  Gain  during  1906 

Table  12  Dairy  Register,  1906 

Table  13  Dairy  Scores,  All  Dairies  Registered,  1906 

Table  14  Dairy  Scores,  Gain  during  1906 

Table  15  Infectious  Diseases  Investigated,  and  Source  Found  in  the  Milk  Supply 
1902-1906 

MEAT  INSPECTION 

Table  16    Inspection  and  Condemnation  of  Meat,  1905-1906 
Table  17    Pounds  of  Meat  Condemned,  1906 


INDEX  TO  EXHIBIT  ^^Continued 


DIVISION  OF  INSPECTIONS— C^;z//;2w^ar 

INSPECTION  OF  FRUIT,  FISH,  AND  OTHER  FOODS 

Table  i8    Inspection  and  Condemnation  of  Fruit,  Fish,  and  Other  Foods,  1905-1906 

Table  19    Pounds  of  Fruit,  Fish,  and  Other  Foods  Condemned,  1906 

Table  20    Summary  of  Food,  Samples  Obtained,  and  Results  of  Analyses,  1906 

INSPECTION  OF  MERCANTILE  ESTABLISHMENTS 
Table  21    Employment  Certificates,  1906 
Table  22    Inspection  of  Mercantile  Establishments,  1906 
Table  23    Summary  of  Inspection  of  MercantUe  Establishments,  1902-1906 

LODGING  HOUSE  INSPECTION 

Table  24    Lodging  House  Inspections,  1905- 1906 

SHORE  INSPECTION 

Table  25    Shore  Inspection,  1905-1906 

COMPLAINTS,  NOTICES,  AND  CIVIL  AND  CRIMINAL  ACTIONS 
Table  26    Complaints  and  Notices :    Division  of  Inspections,  1906 

Table  27    Violations  Forwarded  to  the  Assistant  Corporation  Counsel  for    Civil 
Action,  1906 

Table  28    Civil  Actions  Brought  by  the  Assistant  Corporation  Counsel,  1906 

Table  29    Criminal  Actions  for  Violation  of  Sanitary  Code,  Charter,  SUtutes,  and 
Ordinances,  1906 

Table  30    Criminal  Actions  in  Magistrates'  Courts,  1906 

Table  31    Criminal  Actions  in  Court  of  Special  Sessions,   1906 


INDEX  TO  EXHIBIT  ^^Continued 


49 


m 


DIVISION  OF  CONTAGIOUS  DISEASES 

DISTRICT  MEDICAL  INSPECTION 

Table  32    Prevalence  of  Contagious  Diseases,  1902-1906 

Table  33    Contagious  Diseases:  District  Medical  Inspection,  1906 

Table  34    Contagious  Diseases:  District  Nurses'  Visits,  1906 

MEDICAL  INSPECTION  OF  SCHOOL  CHILDREN 

Table  35    Prevalence  of  Contagious  Diseases  in  School  Children,  1902-1906 

Table  36    Contagious  Diseases  Found  in  Schools  by  Inspectors  and  Nurses,  1906 

Table  37    Medical  Inspection  of  School  Children  for  Contagious  Diseases,  1906 

Table  38    Prevalence  of  Communicable  Eye  and  Skin  Diseases  in  Schools  in  which 
there  are  Nurses,  and  Proportion  of  Exclusions  therefor,  1902-1906 

Table  39    Examination   and  Treatment  of  School  Children  for  Non-contagious 
Physical  Defects,  1906 

Table  40    Medical  Examination  of  School  Children :     Non-contagious  Physical 
Defects  Found  and  Treated,  1906 

Table  41    Promotions  among  Children  Treated  and  not  Treated  for  Adenoids,  1906 

Table  42    Nationality  of  School  Children  Found  Defective,  Needing  Treatment,  1906 

SUMMER  CORPS 

Table  43    Summer  Corps,  1906 

Table  44    Summer  Corps :  Summary,  1902-1906 

Table  45    Methods  of  Feeding  of  Children  Registered  by  Summer  Corps,  1906 

Table  46    Methods  of  Feeding  of  Children  Dying  from  Diarrheal  Diseases  and 
Investigated  by  Summer  Corps,  1906 

VACCINATION 

Table  47    Vaccinations  in  Schools,  1906 

Table  48    Total  Vaccinations  by  Department  of  Health,  1906 

Table  49    Vaccinations  by  Department  of  Health,  1902- 1906 

DISINFECTION 

Table  50    Disinfection  of  Premises,  1906 
Table  51    Goods  Disinfected  or  Destroyed,  1906 

INSPECTION  OF  ANIMALS 

Table  52    Animal  Inspection,  1906 

DEPARTMENT  STABLES 

Table  53    Department  Stables,  1906 


50 


II 


Table  54 
Table  55 

Table  56 
Table  57 

Table  58 
Table  59 
Table  60 
Table  61 
Table  62 
Table  63 
Table  64 
Table  65 

Table  66 

Table  67 


INDEX  TO  EXHIBIT  ^—Continued 

DIVISION  OF  COMMUNICABI.E  DISEASES 

Tuberculosis  :    General  Figures,  1897-1906 

Deaths  from  Pulmonary  Tuberculosis  and  Tubercular  Meningitis,  0-15  years, 
1897-1906 

Tuberculosis  Register :    Living  Cases,  1906 

Summary  of  District  Inspection  of  Tuberculosis,  and  of  Treatment  by  the 
Department  Clinics,  1906 

Tuberculosis:    District  Inspection,  1906 

Tuberculosis  Clinics,  1906 

Diphtheria  :    General  Figures,  1897- 1906 

Diphtheria  :    Injection,  Intubation,  and  Immunization,  1906 

Typhoid  and  Cerebro-Spinal  Meningitis  :  General  Figures,  1897- 1906 

Typhoid  Fever  :     General  Figures  and  Inspection,  1906 

Cerebro-Spinal  Meningitis  :   General  Figures  and  Inspection,  1906 

Summary  of  Inspections,  Visits,  etc..  Division  of  Communicable  Diseases, 
1905-1906 

Diagnosis  Laboratory  :    Specimens  Examined,  and  Results  of  Examination, 
1906 

Diagnosis  Laboratory  :    Specimens  Submitted  for  Examination,  1906 


INDEX  TO  EXHIBIT  ^—Continued 


51 


,f^. 


HOSPITALS 


Table  68 

Table  69 
Table  70 
Table  71 
Table  72 
Table  73 
Table  74 
Table  75 
Table  76 
Table  77 
Table  78 


Hospital  Treatment  of  Contagious  Diseases :  Cases  Treated,  and  Percentage 
of  Total  Cases  Reported,  1902-1906 

All  Department  of  Health  Hospitals :    Patients  during  1906 

Reception  Hospital :    Patients  during  1906 

Willard  Parker  Hospital :    Patients  during  1906 

Riverside  Hospital :    Patients  during  1906 

Kingston  Avenue  Hospital :    Patients  during  1906 

Otisville  Sanatorium  :    Patients  during  1906 

Reception  Hospital :    Service  Rendered,  1906 

Willard  Parker  Hospital :    Service  Rendered,  1906 

Riverside  Hospital :    Service  Rendered,  1906 

Kingston  Avenue  Hospital :    Service  Rendered,  1906 


Table  79 

Table  80 

Table  81 

Table  82 

Table  83 

Table  84 

Table  85 

Table  86 

Table  87 

Table  88 

Table  89 

Table  90 

Table  91 


nOSVVTAJjS— Continued 

Otisville  Sanatorium  :    Service  Rendered,  1906 

Reception  Hospital :    Case  Fatality,  1906 

Willard  Parker  Hospital :     Case  Fatality,  1906 

Riverside  Hospital :  Case  Fatality,  1906 

Kingston  Avenue  Hospital :    Case  Fatality,  1906 

Cases  of  Infection  within  Hospitals,  1906 

Otisville  Sanatorium  :    Patients  Treated,  and  Condition  when  Discharged, 
1906 

Otisville  Sanatorium  :    Duration  of  Patients'  Stay,  1906 

Otisville  Sanatorium  :    Places  to  which  Patients  Discharged,  1906 

Trachoma  Hospital  and  Dispensaries :    Number  and  Percentage  of  Apparent 
Cures,  1902-1906 

Trachoma  Hospital  and  Dispensaries  :     Special  Annual  Investigation 

Trachoma  Hospital  and  Dispensaries  :    Treatment  and  Disposition  of  Cases, 
1906 

Trachoma    Hospital    and    Dispensaries :      Examinations,    Diagnoses,    and 
Treatments,  1906 


LABORATORIES 

RESEARCH  LABORATORY 

Table  92  Production  of  Antitoxic  Serums  and  Diagnostic  Toxins,  1905-1906 

Table  93  Bacteriological  Examination  of  Specimens,  1905-1906 

Table  94  Pasteur  Treatment,  1905- 1906 

CHEMICAL  LABORATORY 

Table  95    Specimens  Submitted  and  Analyzed,  1905-1906 

Table  96    Results  of  Analyses,  1906 

Table  97    Number  of  Half  Days  of  Attendance  at  Court,  1905-1906 

VACCINE  LABORATORY 

Table  98    Virus  Produced,  Tested,  and  Issued,  1905-1906 

REMOVAL  OF  DEAD  ANIMALS,  OFFAL,  AND  NIGHT  SOIL 

Table  99    Dead  Animals,  Offal,  and  Night  Soil  Ordered  Removed,  1906 


5* 


Object 


Activities 


Relation  of 
Activities 
to  Objects 


Exhibit  4— Continued 
GENERAL  SANITARY  INSPECTION 

The  promotion  of  public  health  by  the  maintenance 
of  general  sanitary  conditions. 

(a)  Investigation  by  inspectors  and  sanitary  police — 
(i)     Of    all    citizens'    complaints    of    unsanitary 

conditions. 

(2)     To  discover  other  unsanitary  conditions  not 
complained  of  by  citizens. 

(b)  Preventive  and  remedial  measures  for  removing, 

in  the  manner  prescribed  by  law,  the  unsani- 
tary conditions  found  illegally  existing. 
The  connection  of  general  sanitary  inspection  with 
the  public  health,  while  entirely  beyond  question,  is 
so  ill-defined  that  seldom  can  measurable  results  rela- 
tive to  the  public  health  be  shown  to  follow  directly 
from  the  work  done.  It  is,  however,  to  be  admitted  on 
general  principles  that  general  sanitary  inspection  is 
necessary  to  render  a  city  a  healthful  and  decent  place 
to  live  in.  This  assumption  made,  specific  judgment 
may  be  passed  as  to  the  kinds  of  unsanitary  conditions 
dealt  with,  the  relative  amount  of  effort  spent  on  them 
(Table  i),  and  the  promptness  of  action  (Tables  2-3). 


Table  i 

Table  i  presents  in  classified  form  the  complaints,  coming  under 
general  sanitary  inspection,  which  are  received  from  citizens  or  filed  by 
inspectors.  The  number  of  complaints  given  in  the  first  column,  in- 
cluding both  those  pending  January  i  and  those  received  and  filed 
during  the  year,  is  exactly  balanced  by  the  five  following  columns.  The 
table  will  show  the  nature  of  the  complaints  on  which  the  bulk  of  the 
work  in  general  sanitary  inspection  is  required  and  the  extent  to  which 
repeated  inspection  has  to  be  resorted  to  in  order  to  secure  enforcement. 


Exhibit  I— Continued 


53 


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54 


Exhibit  4 — Continued 


r      » 


Tables  2  and  3 

Promptness  in  investigating  complaints  and  in  taking  whatever 
action  is  necessary  is  an  important  indication  of  the  efficiency  of  an  in- 
spection force.  While  the  promptness  of  inspection  can  be  judged  with 
exactness  only  by  a  continual  examination  of  the  daily  or  weekly  office 
records,  Tables  2  and  3  afford  a  sufficiently  accurate  basis  on  which  to 
judge  the  work  of  the  year  as  a  whole. 


Table  4 


Table  4  is  in  the  same  form  as  the  corresponding  table  in  the  present 
annual  report. 


f 


Exhibit  4 — Continued 


55 


Table  2 


GENERAL     SANITARY    INSPECTION:     COMPLAINTS     DISPOSED     OF 

WITHIN   30  AND  60  DAYS,   1906 


New  York 
Manhattan 
Bronx    . . . , 
Brooklyn 
Queens    . . . 
Richmond 


Complaints  and 
ensuing:  actions 
disposed  of*  in 
1906 


Disposed  of* 
within  30  days 


No. 


Disposed  of* 
within  60   days 


No. 


Not   disposed 
of*  within  60 
,     days 


No. 


In  this  table,  the  complaint  and  ensuing  notice  or  legal  action  (if  any)  are  all  counted  as 
parts  of  one  operation.  Complaints  disposed  of."  therefore,  in  this  table  includes  (1)  citizens' 
complaints  returned  negative  (no  cause  for  action;  the  complaint  beinfj  without  cause,  or  the  cause 
being  removed  without  issuance  of  notice):  (2)  all  notices  complied  with,  no  matter  whether  oriein- 
ating  with  complaints  of  citizens  or  inspectors,  and  no  matter  whether  before  or  after  lejral 
action.  The  periods  SO  and  60  days  are  counted  from  the  date  of  first  receiving  the  complaint  to 
the  last  date  of  its  return  as  negative,  or  removal  of  cause  of  complaint  (notices  complied  with) 

Table  3 

GENERAL     SANITARY     INSPECTION:     COMPLAINTS     PENDING 
DEC    31,    1906,    lAND    WHEN    RECEIVED 


New  York 

Manhattan 

Bronx 

Brooklyn 

Queens 

Richmond 

No. 

*of 
total 

No. 

<of 
total 

No. 

total 

No. 

<of 
total 

No. 

5<Of 

total 

No. 

*of 
total 

Complaints  and  ensuing  ac- 
tions* pending 

Complaints  first  received  in 
December,      1906 

100 

lOO 

lOO 

100 

100 

lOO 

November,      1906 

October,          1906 

September,      1906 

August,           1906 

July,                1906 

June                1906 

May,               1906 

April,               1906 

March,            1906 

February,       1906 

January,         1906 

Total            1906 

1905 

1904 

*In  this  table,  the  complaint  and  ensuing  notice   or   letral   action    (\f   9nv">    ar*   all    ^»..„«^^.4    — 
parts  of  one  operation,  which  may  be  pending^t  any  on%  of  its^ft^S^s^ee  n';,\eTndJr  fable  2    " 

Table  4 
PREMIISES    ORDERED    VACATED,*    1906 

For  city  and  each  of  five  boroughs 


Number 


Date 


Location 


Cause 


Result 


•Section*   117«   and    1299   of   Chapter    466,    Laws  of  190L 


56 


Exhibit  4  ^Continued 


Object 


Activities 


Relation  of 
Activities 
to  Object 


MILK  INSPECTION 

The  promotion  of  the  public  health  as  affected  by 
the  milk  supply. 

(a)  Within  the  city: 

Inspection  of  milk  in  stores,  on  wagons,  and 
to  some  extent  at  receiving  stations,  to  see 
that  it  is  unadulterated,  sweet,  and  not  above 
50°  Fahr.  in  temperature;  and  inspection  of 
stores  and  wagons  to  see  that  sanitary  con- 
ditions are  maintained  where  milk  is  sold. 

(b)  Chiefly  outside  the  city: 

Inspection  of  creameries  and  dairies  supply- 
ing milk  to  the  city,  to  secure  sanitary  con- 
ditions. 

(c)  Either  inside  or  outside  the  city: 

Investigation  of  cases  of  infectious  diseases 
suspected  to  have  resulted  from  the  contam- 
ination of  the  milk  supply. 
It  is  agreed  that  there  is  an  intimate  connection 
between  the  deaths  from  diarrheal  diseases  of  chil- 
dren under  one  year  of  age  and  the  condition  of  the 
milk  supply.  To  what  extent  other  factors — such  as 
the  work  of  the  summer  corps,  pasteurization,  varia- 
tions in  the  ice  supply,  in  the  temperature,  and  hu- 
midity— enter  in  to  modify  the  exactness  of  this  rela- 
tion is  of  course  open  to  debate;  but  it  is  safe  to  say 
that  the  relation  is  sufficiently  close  so  that  any 
thoroughgoing  measure  adopted  by  the  department 
of  health  to  protect  the  milk  supply  would  be  effec- 
tive to  a  greater  or  less  degree  in  reducing  the  infant 
death  rate  from  diarrheal  diseases  (Tables  5-6). 


f       ♦ 


%      • 


Eochibit  4 — Continued 

To  reinforce  this  evidence,  systematic  bacteriological 
tests  should  be  made.  An  analysis  of  several  thousand 
samples  each  year,  so  taken  as  to  distinguish  pasteur- 
ized from  unpasteurized  milk,  and  so  distributed  as  to 
be  fairly  typical  of  the  total  milk  supply,  would  furnish 
a  fair  indication  of  the  relative  cleanliness  of  the  milk 
supply  from  year  to  year  (Tables  5  and  7).  A  study 
of  results  will  enable  the  department  to  decide  whether 
its  "warning"  line  shall  be  drawn  at  1,000,000  or 
500,000,  etc. 

Further  evidence  to  the  same  point  would  be  afford- 
ed by  the  reports  showing  the  conditions  in  cream- 
eries and  dairies  (Tables  9-14).    See  Exhibit  9. 

In  addition,  there  should  be  statements  showing 
how  strong  the  presumption  is  that  a  large  proportion 
of  the  adulterated  milk  is  discovered.  For  this  pur- 
pose, statements  for  a  single  year  convey  little  mean- 
ing. If,  however,  a  statement  covering  several  years 
shows,  relative  to  the  frequency  of  inspection  (assum- 
ing the  same  efficiency  throughout)  an  increase  or 
decrease  in  the  proportion  of  bad  conditions  to  good, 
there  is  a  basis  for  inference  as  to  whether  conditions 
generally  are  becoming  better  or  worse  (Table  5). 

The  tracing  of  infectious  diseases  to  their  possible 
origin  in  the  milk  supply  is  virtually  a  kind  of  detec- 
tive work.  It  varies  so  from  time  to  time  that,  while 
its  results  should  be  reported,  they  indicate  little  as 
to  department  vigilance  (Table  15). 


57 


58 


Exhibit  i^Continued 


Table  $ 


Table  5  is  a  summary  for  five  years  of  facts  given  in  more  detail  for 
the  current  year  in  Tables  6-8.  It  is  intended  to  exhibit  whatever  corre- 
spondence there  may  be  between  the  infant  death  rate  and  the  cleanli- 
ness of  milk  supply  (which  reflects  the  work  of  creamery  and  dairy  in- 
spection) and  the  results  of  city  inspection.  With  a  diminishing  per- 
centage of  samples  containing  over  1,000,000  bacteria  per  cubic  centi- 
meter, a  fall  in  the  death  rate  might  be  expected. 

In  the  other  columns,  assuming  the  same  degree  of  efficiency,  if  the 
frequency  of  inspection  remains  the  same  over  several  years,  while  the 
percentages  of  inspections  finding  adulteration  or  milk  above  50**  in- 
crease, the  inference  would  be  that  conditions  are  growing  worse,  and 
that  more  inspection  was  needed :  on  the  other  hand,  under  the  same  con- 
ditions, a  falling  off  in  the  percentage  of  adulterations  found  would 
argue  an  improvement. 


Table  6 


The  relation  between  the  deaths  from  diarrheal  diseases  of  children 
under  one  year  of  age  and  the  condition  of  the  milk  supply  is  seen  most 
clearly  in  the  summer  months,  when  the  milk  supply  is  at  its  worst  and 
when  children  have  in  general  least  vital  resistance  to  disease. 


Exhibit  4^Continued 


59 


Table  5 


9    !    ♦♦ 


COMPARATIVE  SUMMARY    OF   INFANT  DEATH   RATE,  CITY  INSPECTION 
AND  BACTERIAL    CONTENT,    TEMPERATURE  AND  ADUL- 
TERATION OF  MILK    SAMPLES,  1902-1906 


Infant  death  rate* 

t 
Bacterial  content 

Inspections^ 

Temperature! 

Adulteration^ 

Deaths  from  di- 
arrheal diseases, 
June  to  Septem- 
ber, of  children 
under  1  per  1,000 
births     during 
12  mos.§ 

Percentage    of 
milk  samples 

containing 
over  1,000,000 
bacteria  per  cu- 
bic centimeter 

Average   num- 
ber inspections 
per  permit  per 
year 

Percentage 

of  inspections 

finding  milk 

above  50° 

Percentage 
of  inspec- 
tions finding 
adulterations 

IJew  York 

1902.  ..  . 

1903.  ..  . 

1904.  ..  . 

1905.  ..  . 

1906.  ..   . 

Hach  borough 

1902.  ..  . 

1903.  ..  . 

1904.  ..  . 

1905.  .   .  . 

1906.   ..  . 

•  See  Table  6 


t  See  Table  7 


X  See  Table  8 


§  The  12  months  ending  Sept.  30 


Table  6 

DEATHS  AND  DEATH  RATE  OF  CHILDREN  UNDER  i  YEAR  OF  AGE  FROM 
DIARRHEAL  DISEASES  DURING  THE  MONTHS  OF  JUNE,  JULY,  AUGUST 

AND  SEPTEMBER,  1902-1906 


New  York 

1902 

1903 

1904 

1905 

1906 

Bach  borough 

1902 

1903 

1904 

1905 

1906 

*  The  12  month  •  ending  Sept.  30 


June 


July 


Aug. 


Sept. 


Total 

4 
months 


Deaths,  4  mos., 
per  1,000  birtlis 
dorlnff  IS  moc* 


6o 


Exhibit  4-^Coniinued 


Table  7 

The  bacterial  content  of  milk  is  not  suggested  as  a  standard  which 
can  be  enforced  as  to  all  milk  sold  in  New  York  City.  It  is  proposed 
however,  as  an  important  index  by  which  the  general  condition  of  the 
milk  supply  can  be  judged  from  year  to  year.  It  can  also,  by  the  proper 
arrangement  of  the  methods  of  taking  the  samples,  be  made  a  basis 
for  comparing  pasteurized  and  non-pasteurized  milk,  milk  pasteurized  in 
the  city  and  in  the  country,  and  non-pasteurized  milk  at  its  different 
stages,  1.  e.,  at  receiving  stations,  at  stores,  and  on  wagons. 


Exhibit  4— Continued 


61 


Table  7 
BACTERIAL    CONTENT    OF    MILK    SAMPLES,     1902  - 1906 


Average  daily  milk  supply  (estimated)  in  gallons  . 

Samples  taken  for  bacterial   examination 

January   

February  

March 

April 

May 

June 

July 

August     

September 

October 

November 

December 


1902 


1903 


1904 


1905 


1906 


NUMBER    OF    SAMPLES 

Year 

Whose  bacterial  content  per  cubic  centimeter  was  found 

Spoiled 

Undar 
100.000 

Between 

100.000  and 

250,000 

Between 

250,000  and 

500,000 

Between 

500,000  and 

1,000,000 

Over 
1.000.000 

Total 

1902 
1903 
1904 
1905 
1906 

PBRCEHTAOE    OF    8AliFX.E8 

Year 

Whose  bacterial  content  per  cubic  centimeter  was  found 

spoiled 

Undar 
100.000 

Between 

100,000  and 

250,000 

Between 

250,000  and 

500.000 

Between 

500.000  and 

1,000,000 

Over 
1.000.000 

Total 

1902 
1903 
1904 
1905 
1906 

100 
100 
100 
100 
100 

I 


I 


i 


62 


Exhilni  i^Continued 


Table  8 


The  bulk  of  city  inspection  is  of  milk  in  the  possession  of  persons 
having  permits  to  sell  either  in  stores  or  on  wagons.  The  field,  there- 
fore, which  city  inspection  has  to  cover  is  approximately  indicated  by 
the  average  number  of  permits  in  force;  and  the  extent  to  which  the 
field  is  covered  is  indicated  by  the  average  number  of  inspections  per 
permit  per  year. 

The  distinction  between  store  and  wagon  is  necessary  because  con- 
ditions vary  so  widely  between  the  two  classes  of  permits.  One  man 
may  hold  a  large  number  of  wagon  permits ;  whereas  one  man  is  not  as 
likely  to  hold  many  store  permits.  This  reason  alone  would  account  for 
a  considerable  difference  in  frequency  of  inspection :  if  a  dealer  maintains 
good  conditions  on  one  of  his  wagons,  there  is  some  presumption  that  he 
will  on  the  rest;  but  in  stores  there  is  no  such  presumption.  If  it  ap- 
peared either  from  the  observation  of  the  supervisory  inspector  or  from 
Table  5  that  more  inspection  was  needed,  the  question  would  arise 
whether  the  added  inspection  should  be  of  stores  or  of  wagons.  This 
would  be  answered  by  the  records  showing  in  each  the  proportion  of  in- 
spections finding  adulterations. 


Exhibit  4 — Continued 


^ 


Table  8 


MILK  INSPECTION  WITHIN  NEW  YORK  CITY,    1906 


Permits  issued  durinsr  1906  *  ' 

Permits  revoked  during  1906 

For  discontinuance  of  selling.  . 

For  violation  of  law 

Average  permits  in  force  in  1906  * 

t 

INSPECTION 

Regular  inspections 

Inspections  at  receiving  stations 

Total 

ATtrair*  Inspeotions  par  perxnit  p«r  y«ar  .  . 

Specimens  examined  t 

Samples  taken 

CONDITIONS  FOUND 

Znspactioiui  flndinff  milk  above   BQo 

%  of  such  di«coTerl«s  to  total  inspections  . 
Inspections  finding*  adulteration  X 

Warning:  ffiven  g 

Prosecuted  § 

i  of  adulterations  found  to  inspections .  .  . 

Rooms  connected  contrary  to  sanitary  code  .... 

Ice  box  badly  drained 

Ice  box  unclean 

Store  unclean 

Utensils  unclean 

Milk  not  properly  cooled 

Infectious  disease 

Persons  found  selling:  without  permit 

ACTION  TAKEN 

DESTRUCTION  OF  MILK 

Itots  of  milk  destroyed  for  bein^f  over  60° 

Quarts  so  destroyed 

Lots  of  milk  destroyed  for  being  sour 

2uarts  so  destroyed      
ots  of  milk  destroyed  for  beinir 

otherwise  adulterated 

Quarts    so  destroyed 

Total  quarts  destroyed ....•* 

NOTICES  ISSUED  || 

To  drain  and  clean  ice  box 

To  clean  store 

CRIMINAL  ACTIONS  BEGUN  H 

For  selling  adulterated  milk ;  .   . 

For  selling:  without  permit 

For  interference  with  inspector 

Total 


New  York 


Stores 


Wafons 


Each  boroug:h 


Stores 


Waeons 


•  Average  in  force  on  the  first  of  each  month 

t  Several  specimens  may  be  examined  at  a  single  inspection 

X  Samples  taken  and  analyzed 

.. }  y^^  technical  definition  of  adulteration  is  found  in  Section  53  of  the  Sanitary  Code,  the  chief  items  bein» 

containing:  less  than  12  per  centum  of  milk  solids"  and  "containing  less  than  3  percentum  S  f^s"' 
?2*'i?^-r!™"*  5  distinction  is  made  between  samples  whose  milk  solids  iri  fouSd  betwSS  l^and  11  5*-' 
12#-n.4#  are  made  occasions  for  warning  only,  under  11.4«  for  prosecution  "ciwccn  i^»  ana  im%. 

I  For  action  upon  notices,  see  Table  26 

t  See  Table  29 


la 


\ih 


Exhilni  4-^Continued 


Tables  g-ii 

The  department  of  health  has  installed  \vhat  is  in  effect  a  register 
of  the  creameries  sending  milk  to  New  York  City,  together  with  a 
score  record  of  their  condition  at  the  last  inspection. 

Table  9  gives  the  number  of  creameries  enrolled,  together  with  the 
number  inspected,  and  the  frequency  of  inspection. 

Table  10  shows  the  number  and  percentage  of  creameries  whose 
condition  is  classed  at  the  beginning  and  at  the  end  of  the  year  as  good 
(between  75%  and  100%),  fair  (between  50%  and  75%),  and  poor 
(under  50%).  The  year's  work  should  bring  about  a  higher  percentage 
of  those  classed  as  good  or  fair.  The  average  score  of  all  creameries 
enrolled  should  also  rise. 

Table  11  is  designed  to  show  wherein  the  improvement  consists. 
The  department  is  in  a  position  to  report  improvement  during  the 
year,  of  course,  only  in  those  creameries  which  it  has  inspected  more 
than  once.  For  these  creameries,  therefore,  the  gain  is  analyzed  accord- 
ing to  the  subdivisions  of  the  score  card  used. 


Tables  12-14 


Tables  12-14  are,  for  dairies,  the  same  as  9-1 1  for  creameries. 


Exhibit  4— Continued  g 

Table  p 

CREAMERY  REGISTER,   1906 

Enrolled  Jan.  l,  1906 

New  creameries  scored  during  1906 

Total 

Creameries  dropped  during:  1906 

enrolled  Dec.  31,  1906 

ToUl .  .  , 

Creameries  inspected  at  least  once 

V«ro«nt»ff«  of  total  iiLsp«ot«d  at  least  onc«  ............ 

Number  of  inspections 

▲T«rair«  ln»p«ctioii«  ptr  7«ar  per  place  l&speoted.  ......./..'..... 


Table  lo 
CREAMERY  SCORES  :    ALL  CREAMERIES  REGISTERED,    1906 


Scores  at  last  inspection 

Number  resistered 

Peroentage  of  total 

Jan.  1.  1906 

Dec.  31.  1906 

Jan.  1, 1906 

Deo.  31, 1906 

Between  75  and  lOOit 

50  and  Ibi 

Below  50it 

Total 

100 

100 

ATera^e  score  at  last  iaspeetlon,  Jan.  I,  1906 . 
"       "       "  "  Dec.  31,  1906 


u 


Table  n 

CREAMERY  SCORES  :    GAIN  DURING  1906 
Creameries  inspected  more  than  once  in  1906 


Perfect  score 


Single 
cream- 
ery 


ToUl 

Location  and  surroundinsrs 

Rooms:  arrangement  and  ventilation 

Walls,  ceiliuKs,  floors 

Drains  and  drainage 

Utensils  and  apparatus 

Water  or  ice  supply,  tanks,  etc. .  .  . 

Methods  of  handling  milk 

•Cleealioest  of  attendants 


100 

8 

16 

16 

12 

13 

22 

7 

6 


Agrgre- 
srate 


At  first 
inspection 


Anrre- 
gate 


ofper< 
feet 

seore 


,  At  last 
inspection 


Aggrre- 
gate 


ofper- 
fSet 

seore 


Gain 


Aggre- 
gate 


t  of 
ffaia 


^  Exhibit  ^-Continued 

Table  12 

DAIRY  REGISTER,  1906 

Enrolled  Jan.  1,  1906 

New  dairies  scored  during  1906  . .  ^ 

Total ..././.,,  ,.,..,, 

Dairies  dropped  during  1906 

enrolled  Dec.  31,  1906 

Toul ..!.!!.!!!!!!!.!! 

Dairies  inspected  at  least  once 

P«ro«ntaff«  of  total  ln8p«ot«d  at  l«Mt  one* 

Number   of  inspections 

▲▼•rsff*  inspttotloiui  p«r  j«ar  p«r  plao«  inspecttd 


Table  13 
DAIRY  SCORES :  ALL  DAIRIES  REGISTERED,  1906 


Scores  at  last  inspection 


Between  75  and  lOOit 
50  and    75« 
Below  50it 


ToUl 


Number  registered 


Jan.  1,  1906 


Dec.  31.  1906 


y«re«ataff«  of  total 


Jaa.  1, 1906 


AT«rar«  Moro  at  last  iaapootioap  Jan.  1, 1»0« 
"      "      "  "         Doe.  81, 1906 


I>«o.  81, 1808 


100 


•f 


Ta:ble  14 
DAIRY  SCORES:  GAIN  DURING  1906 


Dairies  inspected  more  than  once  in  1906 


Total 

Condition  of 

Stables  

Cow  yard 

Cows 

Milkers  and  milking 

Utensils 

Milk  house 

Water  supply  .... 


Perfect  score 


Single 
dairy 


Aggre- 
gate 


100 

40 
3 

21 

13 
6 
7 

10 


100 


At  first 
inspection 


Aggre- 
gate 


ofpor- 
foot 


At  last 
inspection 


Aggre- 
gate 


ofpor- 

foot 

■ooro 


Gain 


Aggre- 
gate 


«of 


Exhibit  4— Continued 


Table  75 

INFECTIOUS   DISEASES   INVESTIGATED   AND    SOURCE    FOUND   IN    THE 

MILK  SUPPLY,   1902-1906 


TYPHOID 

Suspected  cases  referred  for  investigation  .  .  .  . 
Cases  of  infection  traced  to  milk  supply 

SCARLET  FEVER 

Suspected  cases  referred  for  investigation   .  .  .  . 
Cases  of  infection  traced  to  milk  supply 


6S 


Exhibit  4 — Continued 


Object 


Activities 


Relation  of 
Activities 
to  Object 


MEAT    INSPECTION 

To  promote  the  public  health  by  seeing  that  the 
meat  slaughtered  or  sold  in  the  city  is  fit  for  con- 
sumption as  food. 

Inspection  of  butcher  shops,  stores,  packing  houses, 
ice-houses,  stands*,  vessels*,  markets,  railroad  depots, 
stock  yards,  slaughter  houses,  commission  houses,  fat 
houses,  and  licensed  venders;*  and  condemnation  of 
meat  found  to  be  unfit. 

The  relation  of  meat  inspection  to  the  public  health 
is  not  so  definite  that  its  adequacy  can  be  measured  in 
health  terms.  It  cannot  be  stated,  even  approximately, 
to  what  extent  the  public  health  is  improved  by  meat 
inspection.  It  is  admitted  on  general  principles,  how- 
ever, that  inspection  of  the  food  supply  is  necessary. 
This  assumption  made,  the  question  is  one  of  covering 
the  supply  as  thoroughly  as  possible. 


Table  i6  , 

Table  i6  shows  the  kinds  of  place  inspected,  the  average  frequency 
of  inspection  of  each,  together  with  the  number  of  condemnations  and 
pounds  of  meat  condemned  in  each.  The  number  of  condemnations  is 
given  separately  from  the  amount  condemned,  in  order  to  indicate  more 
accurately  the  amount  of  work  involved.  It  would  take  more  inspections, 
for  example,  to  condemn  a  given  amount  of  meat  in  butcher  shops  than  in 
packing  houses. 

Conditions  vary  from  year  to  year  to  such  a  degree  that  comparison 
with  more  than  one  preceding  year  would  probably  be  of  little  value. 


*  The  number  of  establishmetits  of  the  kinds  indicated  (*)  is  so  variable  that  the  averase  number 
of  inspections  of  each  per  year  would  mean  little.  For  the  rest,  however,  such  a  figure  would  afford  « 
basis  for  comparing  successive  years. 


Exhibit  4 — Continued 


69 


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70 


Exhibit  4— Continued 


Exhibit  4^ Continued 


n 


o 


Table  1/ 

Table  17  is  simply  a  subdivision  of  column  5  of  Table  16,  to  show 
what  kinds  of  meat   are  condemned  in  the  different  places. 


B 
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« 
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ToUl 


72 


II: 


ill 


Object 


Activities 


Relation  of 
Activities 
to  Objects 


Exhibit  4— Continued 

INSPECTION  OF  FRUIT,    FISH,   AND   OTHER 

FOODS 

To  promote  the  public  health  by  seeing  that  the 
fruit,  vegetables,  fish,  and  other  foods  (chiefly  canned 
goods,  confectionery,  groceries,  and  eggs)  that  are  sold 
are  in  fit  condition  to  serve  as  food. 

(a)  Inspection  of  commission  houses,  retail  stores, 
licensed  venders,  vessels  and  wharves,  railroad 
depots,  stands,  markets,  ice  houses,  and  push  carts; 
and  condemnation  of  foods  found  to  be  unfit. 

(b)  Gathering  of  samples  of  confectionery,  canned 
goods,  etc.,  for  analysis ;  and  initiating  action  against 
dealers  whose  foods  are  found  adulterated. 

(c)  In  connection  with  both  (a)  and  (b),  the  san- 
itary inspection  of  the  places  where  foods  are  sold  or 
manufactured. 

The  process  of  marketing  perishable  foods  is  so 
subject  to  fluctuations  that  no  definite  formulation 
can  be  made  of  the  conditions  under  which  the  work 
is  carried  on.  A  commission  house  may  be  selling 
fruit  one  week  and  not  the  next;  cargoes  arrive  ir- 
regularly; and  the  methods  of  handling  are  such  that 
the  number  of  inspections  per  place  cannot  be  taken 
as  a  fair  standard  of  judgment.  All  that  is  suggested 
for  an  annual  report,  therefore,  is  the  statement  of 
inspections,  condemnations,  and  amount  condemned 
in  each  kind  of  place.* 


Table  i8 


In  Table  i8,  as  in  Table  i6,  a  distinction  is  made  between  con- 
demnations and  amount  condemned,  in  order  to  show  more  accurately 
the  amount  of  work  involved. 


•S««  paje  19 


Exhibit  4— Continued 


73 


Table  i8 

INSPECTION    AND    CONDEMNATION    OF    FRUIT,     FISH 
AND  OTHER  FOODS,   1905-1906* 


NEW  YORK 


Commission    houses 

Retail    stores    , 

Licensed  venders  . . . 
Vessels  and  wharves 

R.    R.    depots    

Stands     

Markets     

Ice  houses   

Push  carts   

Total    


Each  of  five  boroughs 


Commission    houses     . 

Retail  stores   

Licensed    venders    ... 
Vessels  and  wharves  , 

R.  R.  depots , 

Stands     

Markets    , 

Ice   bouses    

Push  carts  

Total     


•The  process  of  marketing  perishable  foods  is  so  subject  to  fluctuations  that  no  more  definite^ 
formulation  can  be  made  than  that  based  on  inspections 


74 


Exhibii  4^Continugd 


Table  ig 

Table  19  is  simply  a  subdivision  of  column  3  of  the  preceding  table, 
to  show  what  kinds  of  food  are  condemned  in  the  different  places 
inspected. 


Table  20 

The  specimens  whose  analyses  arc  reported  in  Table  20  are  used 
for  the  most  part  as  the  basis  for  legal  action  against  the  dealer  from 
whom  they  were  obtained.  The  approximate  extent  to  which  they  are 
so  used  can  be  seen  by  comparing  Table  20  with  the  criminal  actions 
initiated  by  this  branch  of  food  inspection,  as  given  in  Table  28. 


H 


Exhibii  4 — Continued 


75 


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5! 

< 

Vegetables 

Canned  goods 

Confectionery 

Groceries 

Ekks 

Pish 

Miscellaneous 

Total 

Fruit 

« 

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n 

tr 

0 
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e 

01 

Vegetables 

Canned  goods 

Confectionery 

Groceries 

Eggs 

Pish 

Miscellaneous 

Total 

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76 


Exhibit  4— Continued 


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Exhibit  4— 'Continued 


77 


MERCANTILE   ESTABLISHMENTS 


To  regulate  certain  conditions  under  which  women 
and  children  may  work  in  mercantile  establishments. 
While  there  is  an  ultimate  health  object,  it  is  too  re- 
mote to  be  of  service  in  measuring  the  results  of 
service  rendered. 

(a)  The  issuance  of  employment  certificates  to 
children  between  14  and  16  years  of  age. 

(b)  The  inspection  of  mercantile  establishments 
to  enforce  the  law  relating  to  the  employment  of 
women  and  children  therein. 

Assuming  efficiency  of  supervision  to  secure  thor- 
ough inspection,  successful  inspection  of  mercantile 
establishments  should  result  in  few  violations  of  law 
existing,  and  therefore  few  violations  found.  Since  a 
large  number  of  establishments  may  need  inspecting 
only  once  or  twice  a  year,  while  others  may  need  al- 
most constant  watching,  the  extent  to  which  this  is 
•done  would  appear  only  from  the  daily  or  weekly  office 
records.  The  most  significant  facts  that  can  be 
brought  out  in  an  annual  report  are  perhaps  the  total 
number  of  mercantile  establishments  inspected  at  all 
during  the  year,  the  number  in  which  violations  of 
law  were  found,  and  the  average  frequency  with  which 
these  latter  were  inspected  during  the  year   (Table 


Object 


Activities 


Relation  of 

Activities 
to  Object 


L 


78 


Exhibit  4 — Continued 


7  able  21 
EMPLOYMENT  CERTIFICATES,  1906 


Applications   for  employment   certificates* 

Granted    

Refused 

By  reason  of  insufficient  education 

By  reason  of  insufficient  tuition 

By  reason  of  insufficient  evidence  as  to  birth 

By  reason  of  physical  incapacity 

By  reason  of  being  under  age 


New 

York 


Certificates  in  force  January  1,  1906.... 

Certificates  granted  during  1906 

Certificates  expiring  during  1906 

Certificates  in  force  December  81,  1906. 


Man- 
hattan 


Bronx 


Brook- 
lyn 


Duplicate  certificates  issued. 


Queens 


Rich- 
mond 


Exhibit  4— 'Continued 


79 


Table  23 


•Children   applying   and    found   over   age   are    considered  as   not   having  applied 

Table  22 
INSPECTION  OF  MERCANTILE  ESTABLISHMENTS.*  1906 


INSPECTION 

Mercantile  establishments  inspected  in  1906.... 

Mercantile  establishments  in  which  violations  of 
law  were  found 


Total   inspections  of  mercantile   establishments. 

Inspections  of  mercantile  establishments  in  which 
violations  of  law  were  found 

AT«rac«  iiuip«otlon8  p«r  7«ar  p«r  •stab- 
ll8]im«iit  w]&«r«  Tlolations  of  law  w«x« 
found 

VIOLATIONS 

Violations  of  law  found 

Children  employed  without  certificates 

M(Ae    

Female    

Basement  occupied 

No  seats  for  females 

No  separate  toilets  for  females 

No  register  kept 

Work  after  7  r.  u 

Work  more  than  9  hours  a  day 

Work  more  than  54  hours  in  a  week 

Law  not  posted 


New 

York 


Man- 
hattan 


Bronx 


Brook- 
Ism 


Queens 


Rich 
mond 


SUMMARY    OF    INSPECTION    OF  MERCANTILE  ESTABLISHMENTS 

1902-1906 


*  For  complaints  and  notices,  see  Table* 26 


New  York 

1902.  . 

1903.  . 
1904  .  . 

1905.  . 

1906.  . 

Manhattan 

1902.  . 

1903.  . 
1904  .  . 

1905.  . 

1906.  . 

Bronx 

1902.  . 

1903.  . 

1904.  . 

1905.  . 

1906.  . 

Brooklyn 

1902.  . 

1903.  . 

1904.  . 

1905.  . 

1906.  . 

Queens 

1902.  . 

1903.  . 

1904.  . 

1905.  . 

1906.  . 

Richmond 

1902.  . 

1903.  . 

1904.  . 

1905.  . 

1906.  . 


Number 

in  which 

violations 

found 


Inspections 
of  places 

where 

violations 

found 


Average 

inspections 

per  place 

per  year 


Number  of  violations 


Children 

without 

certificates 


Other 
violations 


ToUI 


So 


Object 
Acti\  ities 


Relation  of 

Activities 
to  Object 


Object 


Activities 


Relation  of 

Activities 
to  Object 


Exhibit  4—Coniinued 


LODGING    HOUSE  INSPECTION 

To  promote  the  public  health  by  maintaining  sani- 
tary conditions  in  licensed  lodging  houses. 

Inspection  of  licensed  lodging  houses. 

As  in  several  other  lines  of  inspection  maintained 
by  the  department  of  health,  it  is  impossible  to  in- 
dicate any  definite  health  results  following  from  the 
work  done.  The  absence  of  epidemics  originating  in 
lodging  houses  is  hardly  a  measurable  piece  of  evi- 
dence. As  for  the  activities  themselves,  they  are  so 
miscellaneous  (cf.  pp.  112-113,  Report  of  1904)  that  re- 
porting them  in  detail  would  be  of  little  value.  All 
that  is  suggested,  therefore,  is  the  number  of  places 
inspected,  the  number  of  inspections  made,  and  the 
average  number  per  place  per  year;  for  the  rest,  it 
must  be  left  to  the  supervising  officer  to  see  that  what 
is  necessary  is  done. 


SHORE    INSPECTION 

To  keep  shores  clear  of  dead  animals  and  offensive 
refuse.  It  is  carried  on  only  in  Brooklyn  and  Rich- 
mond. 

Inspection  of  shores. 

No  definite  health  results  can  be  ascribed  to  shore 
inspection.  Even  the  inspection  itself  cannot  be 
formulated  with  sufficient  definiteness  to  be  of  value. 
A  purely  formal  report  is  given  of  the  number  of  in- 
spections and  of  the  number  of  objects  removed  from 
the  shore. 


Exhibit  4 — Continued 


81 


Tabu  24 


LODGING  HOUSE  INSPECTION,    1905.1906 


New  York. 
Manhattan 
Bronx  .  .  . 
Brooklyn  . 
Queens .  .  . 
Richmond  . 


Permits 


Inspections 


Average  inspections  per 
lodsrins:  house  per  year 


1906 


1905 


Table  2s 
SHORE   INSPECTION,    1905-1906 


Brooklyn 

Richmond 

1905 

1906 

1905 

1906 

Inspections 

1 

Pound  and  disposed  of 
Human  bodies 

Carcases  of  animals 

Dogs 

Cats 

• 

Rats 

Goats 

Sheep  

Hogs 

Catves :...... 

Horses 

Fowls 

Fish 

Bedding,  pieces 

Clothing,  pieces 

Meats,  pieces 

Offal,  pieces 

Mattresses,  number 

u. 


82 


Exhilnt  4^Cl>ntinued 


COMPLAINTS  AND  NOTICES 


Table  26 


Instead  of  taking  space  for  a  statement  of  complaints,  arrests,  etc., 
in  the  report  on  each  line  of  inspection,  it  has  seemed  better  to  make  a 
single  statement  for  all.  Table  26  presents,  for  each  line  of  inspection, 
the  complaints  received  from  citizens,  those  filed  by  inspectors,  the  va- 
rious  dispositions  made,  and  action  (if  any)  taken,  together  with  the 
cases  pending  in  different  stages  at  the  close  of  the  year. 


Exhibit  4— Continued 


83 


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Total 


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Fruit,  fish, 
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"*  •  Exhibit  4— Continued 

CIVIL  AND  CRIMINAL  ACTIONS 

Table  2j-ji 

Persistent  violations  of  law  may  be  forwarded  to  the  assistant 
corporation  counsel  who  thereupon  issues  a  notification  of  intention 
to  commence  civil  action ;  if  the  compliance  is  secured  by  this  notifica- 
tion alone,  suit  is  not  brought ;  continued  non-compliance  results  in  suit. 
Actions  are  discontinued,  however,  at  almost  any  stage  if  compliance 
is  obtained. 

Table  27  gives  the  total  violations  handled  by  the  assistant  cor- 
poration counsel  for  civil  action,  Table  28  the  total  suits  actually 
brought,  together  with  their  disposition.  There  is  no  exact  relation  be- 
tween the  number  of  violations  on  which  suit  is  begun  and  the  number 
of  suits  begun,  for  the  reason  that  several  suits  may  be,  under  various 
circumstances,  brought  on  one  violation. 

The  number  of  actions  arriving  at  the  point  of  judgment  is  too 
small  to  warrant  their  classification  according  to  the  violations  of  the 
law  with  which  they  originated.  Not  so,  however,  with  the  criminal 
actions.  Out  of  2724  cases  in  1905,  2321  resulted  in  conviction  in  the 
same  year, — a  sufficiently  large  number  to  justify  classification,  as  in 
Table  2^, 

Upon  a  judgment  being  vacated  it  becomes  an  action  pending,  and  is 
then,  after  the  order  is  reported  complied  with,  counted  as  a  civil  action 
discontinued. 


Table  29 

Table  29  is  a  modification  of  a  table  now  given  in  the  annual  re- 
ports of  the  department  (see  page  152,  Report  of  1904).  The  new 
form  is  designed  to  show  for  each  line  of  inspection  and  for  each 
borough  the  criminal  actions  begun,  whether  by  arrests  or  summons, 
and  the  results  of  the  actions.  It  is  intended  to  include  all  crim- 
inal actions  initiated  by  the  department,  whether  in  magistrates'  courts 
or  in  special  sessions.  The  subdivision  between  these  is  made  in 
Tables  30-31. 


Exhibit  4 — Continued 

Table  27 

VIOLATIONS    FORWARDED   TO   THE   ASSISTANT   CORPORATION 

COUNSEL  FOR  CIVIL  ACTION,  1906 


85 


VIOLATIONS  RECEIVED 
Violations  pending  January  i,  1906 

Violations   received  and  notices   sent 

Total  violations  during   1906 

DISPOSITION 

Complied  with  before  suit 

Suit  begun 

Pending  (without  suit)  December  81,  1908  and 
awaiting  instruction  by  department  of  health 

Total  violations  during  1906 


New       Man- 
York    hattan 


Bronx 


Brook- 
lyn 


Queens 


Rich- 
mond 


Table  28 

CIVIL  ACTIONS  BROUGHT  BY  THE  ASSISTANT    CORPORATION 

COUNSEL,  1906 


ACTIONS  BEGUN 

Civil  actions  pending  January  1,  1906 

Civil  actions  begun  in  1906  to  recover  penalties 
on  violations 

Other  civil  tctions  begun 

Judgments   vacated* 

Total  suits  during  1906 


DISPOSITION 
Discontinued;  compliance  secured. 

Judgment  recovered 

Pending  December  31,  1906 

Total  suits  during  1906 


Amount  of  costs,  penalties  and  judgments  col- 
lected in  civil  actions  and  paid  to  secretary  of 
board   of   health 


Amount  of  claims  collected  before  and  after  suit 
for  antitoxin  and  virus  and  paid  to  secretary 
of   board    


New 

York 


Man- 
hattan 


Bronx 


Brook- 
Ijm 


Queens 


Rich- 
mond 


•Upon  a  judgment  being  vacated  it  becomes  an  action  pending,  and  is  then,  after  the  order  it 
reported  complied  with,  counted  as  a  civil  action  discontinued 


!l 


86 


Exhibit  4^Continued 


8 
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summons 


Presence  of 
patrolman 


Total 


Sentence 
suspended 


Discharsed 


Pending 
Dec.  31 


Total 


Amount  of 
Pines 


2 


Warrant  or 
Summons 

Presence  of 
patrolman 


Total 


Sentence 
suspended 


Discharged 


Pending 
Dec.  31 


ToUl 


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Exhibit  4— Continued 


87 


Table  30 


CRIMINAL  ACTIONS  IN  MAGISTRATES'  COURTS,  1906 


CASES 

Pending  January  i,  1906,  in  Magistrates*  Courts. 

New  cases  during  1906  in  Magistrates'  Courts.. 
Total  cases 

DISPOSITION 
Held  for  Special  Sessions 

Discharged  

Fined   

Sentence  suspended 

Appealed    

Fending  December  31,  1906 

Total  cases  

Amount  of  fines 


New 
York 


Man- 
hattan 


Bronx 


Brook- 
lyn 


Queens 


Rich- 
mond 


Table  31 
CRIMINAL  ACTIONS   IN   COURT   OF   SPECIAL   SESSIONS,   1906 


CASES 
Pending  January  i,  1906 

Transferred  from  Magistrates'  Courts. 

New  cases  during  1906 

Total  cases 


DISPOSITION 
Discharged 

Fined    

Sentence  suspended 

Appealed    

Pending  December  81,  1006. 

Total  cases 


New       Man- 
York    hattan 


Amount  of  fines. 


Bronx 


Brook- 
13m 


Queens 


Rich- 
mond 


Object 
Activities 


I 


Relation  of 
Activities 
to  Object 


ExhiHi  4^Continued 


CONTAGIOUS   DISEASES:   DISTRICT f  MEDICAI. 

INSPECTION 

To  diminish  the  prevalence  of  contagious  diseases. 

(a)  Inspection  of  cases  reported  by  attending  phy- 
sicians and  school  inspectors  and  through  complaints. 

(b)  Either  quarantining  or  sending  to  a  hospital 
the  cases  found. 

(c)  Ordering  of  disinfection. 

Over  a  series  of  years  there  should  be  a  decreasing 
prevalence  (case  rate)*  of  contagious  diseases  (Table 
32),  though  the  decrease  could  not  correspond  with 
exactness  to  the  amount  of  work  done  in  district  med- 
ical inspection  alone,  since  other  lines  of  work  con- 
tribute to  the  same  result,  such  as  disinfection,  school 
inspection  and  hospital  treatment.  District  medical 
inspection,  however,  is  the  main  factor.  It  is  recog- 
nized, of  course,  that  allowance  must  be  made  for  the 
recurring  waves  of  epidemic  or  partial  epidemic;  yet 
in  these,  the  successive  waves  may  be  expected  to 
show  a  gradual  decline. 

To  assist  in  the  work  of  inspection  of  contagious 
diseases,  there  are  in  Manhattan  alone  a  few  (at  pres- 
ent, two)  district  nurses.  Their  work  is  so  varied,  so 
largely  educative,  so  closely  allied  to  that  of  district 
inspection,  as  to  make  it  impracticable  to  attempt  an 
entirely  independent  statement.  Table  34  seems  as 
much  as  is  now  feasible. 


*  See  iMkget  22,  23  and  24 


Exhibit  4'~Continu^d 


n 

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Exhibit  4— Continued 


Table  33 

Table  33  gives,  for  each  disease,  the  number  of  cases  reported  and 
their  disposition,  the  frequency  of  inspection  of  cases  quarantined  at 
home,  the  number  of  other  inspections,  and  the  number  of  disinfections  of 
premises  and  of  goods  ordered. 

The  most  significant  figure  is,  perhaps,  that  of  the  average  number 
of  visits  per  case  quarantined  at  home  for  its  entire  course,  from  which 
an  approximate  idea  may  be  obtained  of  the  thoroughness  of  the  sur- 
veillance which  the  department  is  able  to  maintain. 

The  number  and  proportion  of  cases  treated  in  the  hospitals  of  the 
department  is  given  in  Table  68.  The  number  of  cases  there  given  as 
treated  will  somewhat  exceed  the  number  given  in  this  table  as  re- 
moved to  hospitals,  on  account  of  the  cases  that  simply  "walk  in." 

The  special  inspections  of  institutions  for  orphans,  destitute  or 
vagrant  children,  or  juvenile  delinquents,  provided  for  in  Chapter  561 
Laws  of  1893,. as  amended  by  Section  2,  Chapter  667,  Laws  of  1900,  are 
given  separately.  ,  .        ..jii 


III  ill 


Exhibit  4— Continued 


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3 

* 


o 
o 

> 

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w 

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09 


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3 

n  M 

MO 

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(* 

a 


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t 

4* 


sr 
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o 

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OD 


7 
t 


Diphtheria 


Scarlet  fever 


Measles 


Small-pox 


Chicken-pox 


German  measles 


Non-contagious 


Total 


5S 

o 


Diphtheria 


Scarlet  fever 


Measles 


Small-pox 


Chicken-pox 


German  measles 


Non-contagious 


Total 


n 

St 


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< 

3 

s 
n 

3* 


91 


o 
o 

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> 

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92 


Objects 


Activities 


Relation  of 
Activities 
to  Object 


Exhibit  4^Continued 


MEDICAL  INSPECTION  OF  SCHOOLS 

(a)  To  diminish  the  prevalence  of  contagious 
diseases  among  school  children,  and  thereby  indi- 
rectly among  children  under  school  age. 

(b)  To  discover  in  school  children  non-contagious 
physical  defects  which  affect  their  power  to  do  school 
work,  and  to  urge  upon  parents  the  necessity  of  treat- 
ment. 

(a)  Systematic  inspection  of  school  children  by 
physicians  and  nurses.  Cases  of  general  communi- 
cable diseases  are  excluded  from  school  and  referred 
to  the  district  medical  inspection  force  for  proper  iso- 
lation; in  cases  of  communicable  diseases  of  eye  and 
skin,  treatment  is  either  given  in  school  by  the  school 
nurses  or  secured  through  their  urging  it  upon  parents. 
In  schools  where  there  are  no  nurses,  the  more  aggra- 
vated cases  of  eye  and  skin  diseases  and  those  per- 
sistently showing  no  evidence  of  treatment  are  ex- 
cluded by  the  medical  inspector. 

(b)  Physical  examination  of  children  and  notifica- 
tion of  parents  when  treatment  is  needed. 

In  so  far  as  the  activities  under  (a)  are  successful,, 
there  should  be,  over  a  series  of  years,  a  decreasing 
prevalence  of  contagious  diseases  among  children  of 

school  age. 

In  so  far  as  the  activities  under  (b)  are  successful^ 
there  should  be  ultimately  a  smaller  proportion  of 
children  who  are  backward  in  their  school  work.  But 
at  present,  records  are  not  available  which  would 
show  definitely  and  on  a  large  scale  the  results  of 
treatment  for  physical  defects:  such  records,  to  avoid 
duplication,  might  best  be  maintained  by  the  depart- 
ments of  education  and  health  jointly.  It  is  feasible^ 
however,  for  the  department  of  health  to  show  in 
certain  selected  schools  the  results  of  treatment  for 
certain  specified  defects  (Table  41)  and  to  show  in 
general  how  far  it  is  able  to  induce  parents  to  secure 
treatment  for  their  children  (Tables  39-40)- 


Exhibit  4 — Continued 


93 


SCHOOL    NURSES 


Objects 


The  work  of  the  inspectors  and  the  nurses  is  so  intimately  related 
that  on  the  whole  it  is  better  to  present  a  combined  report.  The  fol- 
lowing considerations,  however,  apply  to  the  nurses  alone: 

(a)  To  cause  a  marked  decrease  in  the  prevalence 
among  school  children  of  communicable  diseases  of 
the  eye  and  skin. 

(b)  To  reduce  to  a  minimum  the  number  of  ex- 
clusions of  children  from  school  on  account  of  such 
diseases. 

"Routine"  inspection  to  discover  all  cases  of  com- 
municable eye  and  skin  diseases  (except  trachoma,  for 
which  the  inspectors  examine)  ;  treatment  according 
to  directions  by  medical  inspectors,  or  securing  of 
treatment  through  instructions  in  school  or  visits  at 
homes.    Cases  of  pediculosis,  however,  are  completely 

in  the  hands  of  the  nurses. 

Success  in  achieving  (a)  should  be  seen  in  a  de- 
creasing prevalence  of  communicable  diseases  of  eye 
and  skin  among  the  children  of  the  schools  in  which 
the  nurses  work.  In  so  far  as  (b)  is  achieved,  a  low 
percentage  should  be  reached  of  exclusions  for  these 
diseases  (Table  38). 

The  comparisons  suggested,  it  will  be  observed,  are 
only  of  year  with  year  in  the  schools  where  there  are 
nurses,  not  of  these  schools  with  others  where  there 
are  no  nurses. 


Activities 


Relation  of 
Activities 
to  Objects 


94 


Exhibit  4 — Continued 


Table  34 
CONTAGIOUS  DISEASES :  DISTRICT  NURSES'  VISITS,  1904-1906 


Diphtheria 

1904 

1905 

1906 

Scarlet  fever 

1904 

1905 

1906 

Measles 

1904 

1905 

1906 


Manhattan  Cnone  in  other  boroughs  thus  far) 


Cases  visited  1         Visits 


Average  visits  per  case 


Exhibit  ^—Continued 


95 


Table  35 

PREVALENCE  OF   CONTAGIOUS   DISEASES  IN  SCHOOL  CHILDREN 

Case  rate  by  years  and  boroughs,  1902-1906 


General  communicable  diseases* 


Number 


Found  by  inspectors 


In 
school 


Among 
absentees 


Reported  by 

attending 

physicians 


Total 


New  York 
1902. 
1903. 
1904  . 
1905. 
1906. 

Manhattan 

1902  . 
1903. 
1904  . 
1905. 
1906. 

Bronx 
1902. 
1903. 
1904  . 
1905. 
1906. 

Brooklyn 

1902. 
1903. 
1904. 
1905. 
1906. 

Queens 
1902. 
1903. 
1904  . 
1905. 
1906. 

Richmond 
1902. 
1903. 
1904  . 
1905. 
1906. 


Vumber  per 

1,000 

re{ristered 

iu  schools 

iiuspectecL 


Communicable  d  iseases 
of  eye  and  skin  t 


Number 

found  by 

inspectors 

and 

nurses 


V  n  mber  per 
1,000 

registered 
in  schools 
inspected 


♦Small-pox,  diphtheria,  scarlet  fever,  measles,  chicken-pox,  mumps,  and  whoopingTcongh; 
excluded  when  found 

t  Trachoma  and  other  contagious  eye  diseases,  ringworm,  impetigo,  scabies,  favus,  and  pedicti* 
losis;  excluded  only  for  persistent  non-treatment 


Exhibit  4^Continued 


Exhibit  4^Continued 


97 


Table  36 

CONTAGIOUS  DISEASES  FOUND  IN  SCHOOLS    BY  INSPECTORS    AND    NURSES:    1906 

Number  and  disposition  of  cases 


General  communicable  diseases 


New  York 

Cases  found  in  schoolst ' 

Cases  excluded  from  school 

Cases  treated  in  school! ■ 

Cases   instructed   in   school,  or  evidence  of 
treatment  furnishedg 

Number  of  treatments! 

Number  of  instructions^ 

Manhattan 

Cases  found  in  schoolst 

Cases  excluded  from  school 

Cases  treated  in  schooU 

Cases   instructed   in   school,   or  evidence  of 
treatment  furnished^    .  .  - 

Number  of  treatments! 

Number  of  instructions! 

Bronx 

Cases  found  in  schoolst 

Cases  excluded  from  school 

Cases  treated  in  school! 

Cases   instructed   in  school,   or  evidence  of 
treatment  furnished! 

Number  of  treatments! 

Number  of  instructions! 

Brooklyn 

Cases  found  in  schoolst 

Cases  excluded  from  school 

Cases  treated  in  school! 

Cases   instructed   in  school,   or  evidence  of 
treatment  furnished! 

Number  of  treatments!  .  '. 

Number  of  instructions! 

Queens 

Cases  found  in  schoolst 

Cases  excluded  from  school   ......... 

Caaes  treated  in  school!       

Cases   instructed   in  school,   or  evidence  of 
treatment  furnished! 

Number  of  treatments! 

Number  of  instructions! .  .  •  . 

Richmond 

Cases  found  in  schoolst 

Cases  excluded  from  school 

Cases  treated  in  school! 

Cases  instructed   in  school,   or  evidence  of 
treatment  furnished! 

Number  of  treatments! 

Number  of  instructions! 


50 


CD 

B 
E. 

? 

M 


It 


B 


s 


H 
o 


Communicable  diseases  of  eye  and  skin 


» 
n 

a* 
o 

B 


B*? 


B 


GO 

n 

p 
o* 

(* 


G 


"  n 

C 


§2. 

M    ■ 


o 


*Other  contaffious  eye  diseases 

tThe  general  communicable  diseases  and  trachoma  by  inspectors  only;  other  diseases  by  nurses  in  schools  where  there  are  nurses,  otherwise  by  inspectors 

!By  nurses  under  prescribed  directions 

!By  nurses 


98 


Exhibit  4— Continued 


Table  37 

Table  37  is  intended  to  show,  for  inspection  of  contagious  diseases 
in  school  children,  the  field  covered  (number  of  schools  and  registra- 
tion), the  frequency  of  inspection  (average  visits  per  school  per  year), 
the  number  of  examinations  of  children  made,  and  finally  the  number 
of  cases  of  disease  discovered,  these  totals  corresponding  to  those  in 
Tables  35  to  36.  In  examinations  of  children  and  cases  discovered, 
the  work  of  the  inspectors  and  of  the  nurses  is  presented  separately. 
The  frequency  of  visits  is  not  given  for  the  nurses  because  their  work 
is  more  accurately  judged  on  the  basis  of  examinations  and  cases. 


Table  38 

While  the  work  of  the  nurses  should  show  in  the  total  results 
stated  for  all  schools  in  the  foregoing  tables,  the  justification  for  their 
work  would  be  brought  out  more  clearly  by  a  brief  separate  statement 
covering  only  the  field  in  which  their  work  lies.  Table  38  is  for  the 
purpose  of  showing  how  far  the  two  main  objects  of  their  work  are 
attained   (See  page  93). 


Table  39 

Table  39  shows,  in  reference  to  examination  of  school  children  for 
non-contagious  physical  defects,  the  field  that  should  be  covered  (the 
total  registration),  the  field  that  is  covered,  the  number  and  proportion 
of  those  examined  who  are  found  to  need  treatment,  and  the  number 
and  proportion  of  those  needing  treatment  who  are  known  to  have 
received  it. 


Exhibit  4^Continued 


99 


Table  37 


MEDICAL    INSPECTION     OF     SCHOOL    CHILDREN     FOR  CONTAGIOUS 

DISEASES,    1906 


FIELD  OF  INSPECTION 

Total   number  of  public  schools 

Registration     

Public   schools   under  inspection 

Registration     

Other  schools  under  inspection 

Registration     

Total  schools  under  inspection 

Total  registration  of  schools  under  inspection. 

Schools  in  which   there  are  nurses 

Registration     

VISITS  TO  SCHOOLS 

By  inspectors  to  public  schools 

By   inspectors   to  other   schools 

▲▼eraiT*  P«i^  ichool  per  year 

Public  eohools 

Other  sohool* 

EXAMINATIONS 

"Morning"    examinations    of    children   by    in- 
spectors*      

General    communicable   diseases   found 

"Routine"   examinations   by  inspectors! 

Cases  found,  eye  and  skin  diseases 

"Routine"  examinations  by  nursest 

Cases  found,  eye  and  skin  diseases 

Special   "routine"   examinations  bv   inspectors 

for    trachoma    

Cases    found 

Total  general  communicable  diseases  found  in 
schools        

Total  case*  found  in  schools,  eye  and  skin 
diseases     

VISITS  TO  HOMES 

By   inspectors    

By  nurses    


New 
York 


Man- 
hattan 


Bronx 


Brook- 
lyn 


Queens 


Rich- 
mond 


*In  "morning**  examinations,  the  inspectors  examine  the  children  referred  to  them  by  teachers 
or  nurses  as  suspected  cases,  or  children  returning  to  school  after  absence  on  account  of  sickness 


t*'Routine*'  examinations  are  made  by  nurses  in  schools  where  there  are  nurses,  otherwise 
by  inq>ectors.  The  entire  class  is  examined  to  discover  any  cases  of  eye  and  skin  diseases  except 
trachoma,  for  which  a  special  "routine"  examination  is  made  by  inspectors  only 


lOO 


Exhilnt   4 — Coniinued 


Table  38 


PREVALENCE  OF  COMMUNICABLE  EYE  AND  SKIN    DISEASES  IN 
SCHOOLS  IN  WHICH  THERE  ARE  NURSES,   AND  PROPORTION  OF 

EXCLUSIONS  THEREFOR,  1902-1906 


New  York  City 

1902  .... 

1903  .... 

1904  .... 

1905  .... 
1906.  ..  . 

Manhattan 

1902.  .  .  . 

1903.  .  .  . 
1904  .... 

1905.  .  .  . 

1906.  .  .  . 

Bronx 

1902.  .  .  . 

1903.  .  .  . 
1904  ...  . 

1905.  .  .  . 

1906.  ..  . 

Brooklyn 

1902.  .  .  . 

1903.  .  .  . 

1904.  ..  . 

1905.  ... 

1906.  .  .  .  , 

<2ueens 

1902.  .  .  .  . 

1903.  ...  , 
.  1904  ....  , 

1905.  .  .  .  . 
1906 

Richmond 

1902 

1903 

1904 

1905 

1906 


Registration* 

of  schools 

in  which  there 

are  nurses 


Cases  found, 

eye  and  skin 

diseases 


Cas«s 
p«r  1,000  of 
r«fiatr»tloa 


Exclusions 
therefor 


Bxolusloiui 

PMT  1,000  Of 

roiristratioa 


I 


p 


'Average  of  the  registration  on  the  last  school  day  of  each  month 


Exhibit  4 — Continued 


loi 


Table  S9 


EXAMINATION  AND  TREATMENT  OF  SCHOOL  CHILDREN  FOR 

NON-CONTAGIOUS  PHYSICAL  DEFECTS,  1902-1906 

Comparative  summary  by  years  and  boroughs 


NEW  YORK 

EXAMINATION 

Total  rcRistration  'in  public  schools 

Number  of  children  examined 

Vorcontaffo  of  total  roffistration 

Number  needing  treatment  

Foroentaffo   of  thoso  examined  needinir 
treatment 

TREATMENT 

Number  known  to  have  been  treated 

Feroentaffe  of  those  needing  treatment 
known  to  haye  been  treated 

EACH  OF  FIVE  BOROUGHS 

EXAMINATION 

Total  registration  in  public  schools 

Number   of   children   examined 

Feroentaff  e  of  total  registration 

Number  needing  treatment 

Feroentage  of  those  examined  needinir 
treatment 

TREATMENT 

Number  known  to  have  been  treated 

Feroentaffe  of  those  needing  treatment 
known  to  have  been  treated 


1902 


1903 


1904 


1905 


1906 


I02 


Exhibit    4 — Continued 


Table  40 

Any  single  child  may  of  course  be  found  to  have  several  defects. 
Table  40  deals  with  the  number  of  defects,  not  the  number  of  children 
found  defective.  The  figures,  therefore,  will  not  correspond  exactly 
with  any  in  Table  39.  A  comparison  of  the  two  will  show,  if  desired, 
the  average  number  of  defects  per  child,  both  found  and  treated. 


Exhibit   4 — Continued 


103 


Table  40 

MEDICAL  EXAMINATION  OF  SCHOOL  CHILDREN:     NON-CONTAGIOUS 
PHYSICAL   DEFECTS    FOUND   AND   TREATED,    1906 


New  York 

Manhattan 

Bronx 

Found 

Beported 
treated 

Found 

Beported 
treated 

Pound 

Beported 
treated 

No. 

i  of  total 
defects 

Vo. 

No. 

ant. 

1.- 

Ho. 

No. 

SB 

Ko. 

DEFECTS 

Adenoids 

Defective  vision  .  . 
Defective   hearing  . 
Bad  nutrition     •  .  . 
Diseased  anterior 

cervical  glands  .   . 
Diseased  posterior 

cervical  glands    . 
Chorea      ...... 

Heart    disease  .  .  . 
Pulmonary  disease 
Skin  disease  .... 

Deformity  of  spine  . 
Deformity  of  chest  . 
Deformity  of 

extremities  .... 
Nasal  breathing .  . 
Defective  teeth  .  .  . 
Defective  palate  .    . 
Hypertrophied 

tonsils 

Defective  mentality 
Total 

DEFECTS 

Adenoids 

Defective   vision  . 
Defective   hearing 
Bad  nutrition  .  •  . 
Diseased  anterior 

cervical  glands  . 
Diseased  posterior 

cervical  glands 

Chorea 

Heart   diseaM 
Pulmonary   disease 
Skin  disease 
Deformity  of  spine 
Deformity  of  chest 
Deformity  of 

extremities  .  .  . 
Nasal  breathing  . 
Defective  teeth  . 
Defective  palate  . 
Hypertrophied 

tonsils 

Defective  mentality 
ToUl 


I04 


Exhihii   4 — Continued 


Table  41 


See  page  92 


Table  42 

The  figures  given  in  this  table,  when  taken  alone,  of  course  mean 
little:  they  must  be  compared  with  the  numbers  of  each  class  in  the 
entire  school  registration.  The  figures  are  provided  for,  however,  at  the 
suggestion  of  a  department  official,  and  in  connection  with  figures 
obtainable  from  the  department  of  education  might  be  of  value. 


Exhibit  4— Continued 


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Relation  of 
Activities 
to  Object 


Exhibit  4 — Continued 


SUMMER    CORPS 

To  diminish  the  prevalence  of  diarrheal  diseases 
during  the  summer  months  among  children  under 
two  years  of  age. 

Investigation  and  inquiry  by  medical  inspectors  and 
nurses  to  discover  cases  of  diarrheal  diseases,  and 
treatment  or  instruction  of  cases  not  attended  by  pri- 
vate physicians. 

The  work  done  is  largely  educational,  consisting  of 
furthering  intelligent  care  and  feeding  of  babies. 
While  attention  is  primarily  directed  towards  the  care 
of  babies  already  sick,  the  instructions  given  should 
operate  both  to  prevent  recurrence  of  sickness  and  to 
avert  new  cases.  The  work  is  thus  both  preventive 
and  curative. 

Since  diarrheal  diseases  are  not  among  those  regu- 
larly reported  to  the  department,  figures  to  show 
their  prevalence  are  difficult  to  get.  The  visits  of 
the  inspectors  and  nurses,  however,  constitute  when 
tabulated  an  approximate  census  in  the  districts  cov- 
ered; on  this  as  a  basis  can  be  stated  the  proportion 
of  cases  found  to  the  total  number  of  children  re- 
corded (Table  43). 


Tables  44-46 

Tables  44-46  are  compiled  from  the  daily  inspection  records.  They 
show  the  relative  prevalence  of  the  different  methods  of  feeding,  and  the 
proportion  of  sickness  and  deaths  accompanying  each. 


Exhibit   4^Continued 


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Nurses 


Inspectors 


Nurse    s 


u 

►i 
O 

o 

K 

B 


o 

B 

n 

B 


o 

B* 

B 
o 

B 


107 


o 
o 


S 

o* 


^ 


io8 


Exhtbii  4— Continued 


Exhibit  4— Continued 


109 


r 


Table  44 
SUMMER    CORPS:     SUMMARY,    1902-1906 


1902 
1903 
1904 
1905 
1906 


Children 
visited 


Cases 

of  diarrheal 
diseases  found 


Cases  per 

1,000  children 

visited 


Children 

treated  by 

department 


Table  45 

METHODS  OF  FEEDING  OF  CHILDREN  REGISTERED  BY   SUMMER 

CORPS,    1906 


Breast  fed 

Milk:  modified , 

Milk:  boiled  at  home 

Milk:  pasteurized,  Straus 

Milk:  pasteurized,  commercial. 

Milk:  condensed 

Patent    food    

Table    food    

Raw   fruit    

Mixed   feeding 

Total     


Under  9  months 


Over  9  and  under  24 
months 


No. 


toUl 


With 
dlar.    dls. 


Vo. 


No. 


*of 
total 


With 
dlar.    difl . 


Vo. 


Table  46 

METHODS    OF    FEEDING    OF    CHILDREN    DYING  FROM    DIARRHEAL 

DISEASES    AND    INVESTIGATED    BY  SUMMER  CORPS,  1906 


Breast    fed    

Milk:  modified 

Milk:  boiled  at  home 

Milk:  pasteurized,  Straus 

Milk:  pasteurized,  commercial. 

Milk:  condensed 

Patent  food  

Table   food    

Raw   fruit    

Mixed  feeding 

Total     


Under  9  months 


No. 


i  of  total 


Over  9  and  under  24 
months 


No. 


i  of  total 


VACCINATION 

To  reduce  to  a  minimum  the  prevalence  of  small- 
pox. 

Vaccination  of  as  many  people  as  possible  at  suffi- 
ciently frequent  intervals.    Vaccination  is  carried  out: 

(a)  By  a  corps  of  school  vaccinators  who  spend 

all  their  time  in  vaccinating  children  in 
the  public  schools.  They  make  a  com- 
plete circuit  of  the  public  schools  in  from 
four  to  five  years  (Table  47). 

(b)  By  school   medical   inspectors,  who    vacci- 

nate on  Saturdays  and  school  holidays, 
and  during  vacation  in  districts  assigned 
to  them;  by  the  summer  corps,  wherever 
the  inspectors  happen  to  find  cases  need- 
ing it;  by  physicians  at  the  department 
offices ;  by  a  special  vaccinator  on  Black- 
well's     Island;     and     by    the    hospitals, 
which  vaccinate  those  entering  for  what- 
ever cause.     Miscellaneous   vaccinations 
may  be  performed  by  other  members  of 
the  department  (Table  48). 
If  everybody   were   vaccinated   effectively   and    at 
sufficiently    frequent  intervals   (once  in  four  years), 
there  would  be  a  minimum  of  small-pox;  in  general, 
the  higher  the  percentage  of  the  people  in  the  city 
who  are  vaccinated,  the  lower  will  be  the  case  rate 
and  death  rate  of  small-pox.     But  other  factors  enter 
in:  district  medical  inspection  in  the  early  discovery 
and  diagnosis  of  the  disease;  disinfection;  and  hos- 
pital care,  which  is  both  preventive  and  curative. 

It  is  to  be  noted  that  in  vaccination  more  than  in 
most  other  lines  of  work  under  consideration,  judg- 
ments are  not  valid  unless  based  on  figures  for  long 
periods,  for  the  reason  that  immunity  may  persist  con- 


Object 


Activities 


Relation  of 
Activities 
to  Object 


no 


Exhibit  4— Continued 

siderably  longer  than  four  years;  and  because,  sec- 
ondly, even  if  immunity  does  sink  to  a  lower  point,  a 
serious  exposure  of  the  city  to  the  disease  may  not 
occur  for  several  years.  Hence  statements  of  small-pox 
prevalence  covering  short  periods  are  practically 
valueless  as  an  index  to  the  efficiency  of  vaccination. 

The  only  way  of  knowing  how  many  persons  at  any 
given  time  need  vaccination  is  so  far  from  accurate 
as  to  be  of  little  value. 

As  the  work  of  the  department  is  organized,  how- 
ever, it  is  possible  to  give  figures  to  show  what  pro- 
portion of  the  school  population  has  been  examined 
in  any  one  year  and  either  vaccinated  or  found  not 
needing  vaccination.  For  the  rest,  since  no  popula- 
tion figures  are  available  for  the  districts  in  which  the 
vaccinations  are  made,  the  best  that  can  be  done  is 
to  express  the  total  number  of  vaccinations  (includ- 
ing those  in  schools)  as  a  percentage  of  the  total 
population.  This  percentage,  when  compared  with 
the  case  and  death  rate  for  a  considerable  number  of 
years,  may  work  out  a  standard  of  the  proportion  of 
the  population  necessary  to  vaccinate  annually. 


Exhibit  4— Continued 


III 


Table  47 


VACCINATIONS    IN    SCHOOLS,    1906 


FIELD  OF  WORK 

Total    public    school    registration 

Re^stration    in    schools    covered   by   school   vac- 
cinators   during    1906 

WORK  PERFORMED 

Children  examined    

Children  vaccinated   by   department  physicians. 

Children  vaccinated    by    other    physicians 

Children  not    requiring    vaccination 

Fereentagre  of  children  examined  to  total 
■cliool  reflristration 


New 
York 


Man- 
hattan 


Bronx 


Brook- 
lyn 


Queens 


Rich- 
mond 


Table  48 
TOTAL  VACCINATIONS   BY   DEPARTMENT   OF   HEALTH,   1906 


Vaccinations  in  public  schools* 

in   other  schools 

**  in    districts    

••  at    offices    

"  at    Blackwell's    Island 

**  at    hospitals     

••  by   summer   corps    

Percentasra  of  vaccinations  to  total  esti- 
mated population  f 

Total    vaccinations    


New 
York 


Man- 
hattan 


Bronx 


Brook- 
lyn 


Queens 


Rich- 
mond 


*By  special  vaccinators  and  by  school  inspectors 
tPossible  duplications  included 


Table  49 
VACCINATIONS    BY    DEPARTMENT    OF    HEALTH,    1902-1906 


1902 
1903 
1904 
1905 
1906 


Vaccinations  by 
department  of  health 


Per  cent,   of 
estimated  population 


112 


Object 


Activities 


Relation  of 

Activities 
to  Object 


Exhibit  4— Continued 

DISINFECTION 

To  assist  district  medical  inspection  in  diminishing 
the  prevalence  of  contagious  and  communicable 
diseases. 

(a)  Disinfection,  as  ordered  by  medical  inspectors, 
of  rooms  or  houses  which  have  been  occupied  by  cases 
of  the  following  contagious  diseases:  small-pox,  diph- 
theria, scarlet  fever,  measles;  by  cases  of  the  follow- 
ing communicable  diseases:  tuberculosis,  typhoid 
fever  (on  request  of  physicians),  cerebro-spinal  men- 
ingitis; and  disinfection  of  stables  occupied  by  cases 
of  glanders  in  horses. 

(b)  Disinfection,  as  ordered  by  medical  inspectors, 
of  bedding  and  other  goods  infected  by  cases  of  the 
above  diseases. 

In  all  the  contagious  diseases  mentioned  and  in 
cerebro-spinal  meningitis,  disinfection,  though  it  does 
not  possess  an  equal  value,  is  now  an  accepted  prac- 
tice; in  general,  all  cases  are  supposed  to  be  disin- 
fected at  their  termination  either  in  private  houses 
by  physicians  (except  small-pox)  or  by  the  depart- 
ment. In  tuberculosis,  disinfection  is  freely  employed, 
chiefly  following  deaths,  removals  from  one  address 
to  another,  from  the  city  and  to  hospitals  or  sanatoria. 
In  typhoid,  disinfections  are  performed  only  at  the 
request  of  physicians.  In  glanders  of  horses,  since 
the  period  of  possible  contagion  is  indefinitely  long, 
and  since  in  practice  it  proves  impossible  to  find  any 
stated  proportion  of  infected  stables,  no  formulation 
is  possible. 

It  is  hardly  feasible  to  demonstrate  the  value  of  dis- 
infection statistically  through  the  ordinary  depart- 
mental routine ;  for  that  purpose,  a  special  experiment 
would  have  to  be  arranged,  in  which  the  conditions 
were  more  thoroughly  under  control.  In  regular  re- 
ports, the  work  performed  is  all  that  it  is  practicable 
to  show. 


Exhibit   4— Continued 


"3 


Table  50 


DISINFECTION    OF    PREMISES,    1906 


DISINFECTIONS  PERFORMED  » 

Scarlet   fever    

Diphtheria     ...,.••    . . . . 

Measles     

Small-pox     

Tuberculosis    

Typhoid    •  • . . . 

Cerebro-spinal    meningitis    

Glanders  of  horses   

Miscellaneous 

Total   

'Number  of  visits,  disinfection  not  performed. 
Number  of  rooms  disinfected 


New       Man- 
York     hattan 


Bronx 


Brook- 
lyn 


Queens 


Rich- 
mond 


*  The  disinfections  performed,  as  shown  in  Tables  50-51,  will  correspond  with  the  disinfections 
ordered,  as  given  in  the  tables  for  district  inspection  in  the  division  of  contagious  and  communicable 
diseases,  with  the  qualification  that  disinfections  in  upper  Manhattan  may  for  convenience  be  per- 
formed by  Bronx  disinfectors 


Table  51 
GOODS    DISINFECTED    OR    DESTROYED,     1906 


New 
York 


Man- 
hattan 


Lots  of  goods*  on  hand  Jan.  1,  1906 

Received  during  1906 

By  order  from  divisions  of  contagious  and 
communicable   diseases    

From   hospitals    

Miscellaneous     

Total   during   1906 

Lots  of  goods  disinfected 

Lots  of  goods  destroyed 

LoU  of  goods  on  hand  Dec.  81.  1906 

Number  of  articles  disinfected   

Number  of  articles  destroyed   


Bronx 


Brook- 
lyn 


Queens 


Rich- 
mond 


*    A  "lot  of  goods"  consists  of  all  the  articles  removed  for  disinfection  or  deatructioB  at  the 
jdote  of  a  case 


114 


Exhibit  4 — Continued 


Object 


Activities 


Relation  of 

Activities 
to  Object 


ANIMAL  INSPECTION 

To  prevent  the  spread  of  contagious  diseases,  chiefly 
glanders,  rabies,  and  tuberculosis,  among  animals,  thus 
indirectly  protecting  the  public  health. 

Inspection  of  suspected  cases  of  these  diseases; 
destruction  of  those  diagnosed  as  true  cases;  ordering 
of  disinfection  (glanders). 

Success  in  this  line  of  work  would  theoretically 
show  in  a  decreasing  prevalence  of  the  diseases  men- 
tioned. As  it  is  impossible,  however,  to  get  with 
accuracy  the  number  of  animals  in  the  city,  the  best 
that  can  be  done  is  to  report  the  absolute  numbers  of 
cases   occurring,   inspected,   and   disposed   of    (Table 

53). 
The  number  of  disinfections  ordered  will  have    no 

fixed   relation   to  the  number   of   cases   found,   since 

some    cases    involve    several   disinfections,   while   in 

others  the  stables  cannot  be  located. 


DEPARTMENT  STABLES 

The  same  qualification  as  in  Tables  50-51  holds  in  Table  53  with 
reference  to  the  calls  of  ambulances  and  goods  wagons.  The  calls  in 
upper  Manhattan  may  be  made  by  the  Bronx  drivers. 

The  last  part  of  the  table  is  designed  to  show  the  amount  of  horse 
service  maintained. 


Exhibit   4— Continued 


115 


Table  52 
ANIMAL    INSPECTION,    1906 


HORSES 

Examinations  of  horses   

Horses  tested  with  mallein 

Glandered  horses  condemned  and  destroyed .... 

Post-mortem    examinations    of    horses 

Inspections   of   stables    

Disinfection   of   stables   ordered 

DOGS 

Examinations  of  dogs  

Animals    referred    to     research     laboratory    for 

diagnosis    of    rabies    

Cases  of  rabies    

cows 

Examinations  of  cows    

Cows  tested  with  tuberculin 

Cows    condemned    

MISCELLANEOUS 
Examinations  of  other  animals 


New 
York 


Man- 
hattan 


Bronx 


Brook- 
lyn 


Queens 


Rich, 
mond 


Table  53 
DEPARTMENT   STABLES,    1906 


AMBULANCE  DRIVERS 

Cases    removed    to    hospitals 

Bodies    removed    to    morgue 

Other  visits  made 

Total  visits    

Number  of  times  ambulances  or  other  vehicles 
disinfected    

GOODS  WAGON  DRIVERS 

Visits,   infected    goods    removed 

Visits,  disinfected  goods  returned   

Other    visits    made    

Total  visits    

STABLE  SERVICE 

Average  number  of  horses  cared  for* 

For  ambulances  and  goods  wagons 

For   executive    officials    

Total  days  care  for  all  horses  

For  ambulance  and  wagon  horses 

For  horses  of  officials   


New 
York 


Man- 
hattan 


Bronx 


Brook- 
lyn 


Queens 


Rich- 
mond 


'Average  of  those  under  care   on  the  lit  of  each  month 


ii6 


Object 


Activities 


Exhibit  4 — Continued 

DIVISION  OF  COMMUNICABLE   DISEASES 

To  diminish  the  prevalence  of  the  diseases  classed 
as  "communicable,"  by  both  preventive  and  curative 
means.  The  main  emphasis  has  so  far  been  placed 
by  the  division  upon  tuberculosis,  diphtheria,  typhoid, 
and  cerebro-spinal  meningitis;  in  pneumonia,  malarial 
fever,  erysipelas,  and  puerperal  septicaemia,  the  work 
of  the  division  has  not  yet  been  developed  to  any 
considerable  extent. 

The  activities  of  the  division  vary  so  with  the  dif- 
ferent diseases  concerned  that  a  separate  statement 
is  required  for  each  disease. 

TUBKRCUI.OSIS 

Registration.  Obtaining  and  recording  the  essen- 
tial facts  in  all  known  cases  in  the  city;  tracing 
of  cases  to  keep  records  up  to  date  (Table  56). 
District  Inspection.  Visits  by  inspectors  where 
disinfection  is  likely  to  be  necessary  (deaths,  cases 
removing  from  city,  to  hospitals  or  sanatoria,  or 
to  other  addresses)  and  to  cases  at  home,  on  com- 
plaint; reference  of  appropriate  cases  to  hos- 
pitals  and  sanatoria;  compulsory  removal  to  hos- 
pitals, when  necessary;  renovation  of  habitations 
(through  the  division  of  inspections)  ;  ordering 
of  disinfection  (Table  58).  Weekly  visits  by 
nurses  to  cases  at  home  requiring  to  be  kept  under 
observation  (Table  58). 

Clinics.      Early    recognition    and    diagnosis    of 
cases;  reference  of  cases  to  hospitals  and  sana- 
toria;  supervision   of   patients    in    their    home 
(Table  59)- 

Diphtheria 

Injection  of  antitoxin;  intubation  of  laryngeal 
cases  needing  intubation;  immunization  of  well 
persons  exposed  (Table  61). 


Exhibit  4 — Continued 

Typhoid 

Cerebro-spinal  meningitis 

Inspection;   requiring    of 
precautions  against  infec- 
tion   (analagous  to  maintenance  of  quarantine)  ; 
ordering  of  disinfection;  investigation  of  sources 
of  infection  (Tables  63-64). 


117 


Malariai.  fever 
Pneumonia 


Investigation    of    death    reports    to 
verify  cause  (Table  65). 

ErYSIPEIvAS 

PuERPERAi,  Septicaemia 

Only    recording    deaths    as 
reported  (Table  65). 

Diagnosis  I^aboratory 

The    diagnosis    laboratory   provides    free    exam- 
ination of  and  report  upon  specimens  submitted 
to  it  for  diagnosis. 
The  terms  in  which  health  results  may  be  measured 
vary  also  with  the  disease. 

In  tuberculosis,  significant  figures  are  difficult  to 
get.  It  is  only  since  1897  that  tuberculosis  has  been 
included  among  the  diseases  compulsorily  reported  to 
the  department  of  health.  Since  that  time,  until 
1906,  there  has  been  an  almost  steady  rise  in  the  num- 
ber of  cases  reported,  a  rise  probably  due  in  the  main 
to  increased  thoroughness  of  reporting.  1906,  how- 
ever, showed  a  decrease  over  1905  in  the  number  of 
cases  reported,  and  it  is  not  unlikely  that  a  sufficient 
completeness  in  reporting  has  been  reached  to  make 
the  number  of  new  cases  reported  (per  1,000  of  popu- 
lation)  a  fairly   reliable   standard   (Table   54).     The 


Activities 


Relation  of 
Activities 
to  Objects 


Tuberculosis 
Case  Rate 


f 


ii8 


Diphtheria 
Case  Rate 


Typhoid 
Case  Rate 


Other  Case 
Rates 


Exhibit  4— Continued 


death  rate  from  all  tuberculous  diseases  and  pulmon- 
ary tuberculosis  can  be  used  as  a  check.  Another  in- 
dex of  progress  in  the  campaign  against  tuberculosis 
is  the  death  rate  of  children  under  15  from  pulmonary 
tuberculosis  and  tubercular  meningitis,  "the  two 
forms  of  tuberculous  diseases  in  which  an  approxi- 
mately accurate  diagnosis  is  likely  to  be  made  in  chil- 
dren. It  is  in  this,  the  youngest  element  of  the  popu- 
lation, that  one  would  first  look  for  definite  results 
from  the  enforcement  of  measures  for  the  restriction 
of  this  disease"  (Table  55). 

In  diphtheria,  the  success  of  the  antitoxin  method 
is  seen  in  the  falling  case  fatality  for  a  series  of  years 
(Table  60).  The  efficiency  of  antitoxin  injection  by 
the  division  may  be  judged  by  comparing  the  case 
fatality  of  the  cases  treated  with  the  general  case 
fatality,  and  with  the  case  fatality  of  the  cases  treated 
by  private  physicians  with  free  antitoxin.  In  im- 
munization, the  number  of  persons  immunized  who 
contract  the  disease  between  two  and  thirty  days 
after  exposure  can  be  given ;  but  of  course  there  is  no 
way  of  knowing  how  many  would  have  contracted 
the  disease  without  immunization  (Table  61). 

In  typhoid  fever  and  cerebro-spinal  meningitis  both 
the  case  rate  and  death  rate  are  of  value  (Table  62). 
In  pneumonia,  malarial  fever,  erysipelas,  and  puer- 
peral septicaemia,  since  no  organized  work  is  main- 
tained which  would  affect  the  public  health,  no  vital 
statistics  are  given. 

The  diagnosis  laboratory  being  a  subsidiary  line  of 
work  no  health  results  can  be  directly  traced  to  its  work.  The  report 
records  the  specimens  examined  and  the  results  of  examination  (Table 
66),  together  with  the  number  submitted  by  members  of  the  depart- 
ment and  by  private  physicians  respectively  (Table  67). 

*BiM:«,  "Administrative  Control  of  Tuberculosis,"  p.  28 


Exhibit  4 — Continued 


119 


Table  S4 
TUBERCULOSIS:  GENERAL  FIGURES,  1897-1906 


Year 


New  York 

1897. 
1898. 
1899. 
1900. 
1901  . 
1902. 
1903. 

1904  . 

1905  . 
1906. 

Manhattan 
1897. 
1898. 
1899. 
1900. 

1901  . 

1902  . 

1903  . 
1904. 
1905. 
1906. 

Bronx 

1897. 
1898. 
1899. 
1900. 

1901  . 

1902  . 
1903. 
1904. 
1905. 
1906. 

Brooklyn 

1897. 
1898. 
1899. 
1900. 
1901  . 
1902. 
1903. 

1904  . 
1905. 
1906. 

Queens 

1897. 
1898. 
1899. 
1900. 

1901  . 

1902  . 
1903. 
1904  . 
1905. 
1906. 

Richmond 
1897. 
1898. 
1899. 
1900. 
1901  . 
1902. 
1903. 
1904. 
1905. 
1906. 


w 


d 

e 
o 

(A 


^1 

0.0 


2.  O 
OB   n 

"     » 
n 

«> 

CA 


3* 


in  rv  M 

<<  "  3* 

^  B  •♦ 

2  O  B* 


CB 
ft 
0) 

•O 

B* 

r*- 

Bf 

CD* 

.^* 
CB 


o 


HI  «  10  fei 

o  •  p"  r 


=.         (1    H  CI* 


B 
n 

o 


S-  o  s^  P 


"2.  '^ 

3*    O 

3*    » 

to 

CB 


9    g* 


3* 


ft 
» 

3* 

(B 


o 


B 
O* 
ft 

"I 

n 


2.2-0 

StJB* 
^  ft  m 

B  o  •-» 


o  o 
P  2. 


•  - 
o 


*Bxcludins  duplicates 


I20 


Exhibit  4— Continued 


Table  55 


DEATHS  FROM  PULMONARY  TUBERCULOSIS  AND  TUBERCULAR 

MENINGITIS,  0-15  YEARS,     1897-1906 


0  -  5 


li 
ii 


New  York 

1897.  . 

1898.  . 

1899.  . 

1900  .   . 

1901  .  . 

1902.  . 

1903.  . 

1904  .   . 

1905  .   . 
1906.  . 

Manhattan 

1897.  . 

1898.  . 

1899.  . 

1900  . 

1901  .  . 

1902.  . 

1903.  . 

1904.  . 

1905.  . 

1906.  . 

Bronx 

1897.  . 

1898.  . 

1899.  . 

1900.  . 

1901  .  . 

1902  .  . 

1903  .  . 

1904  .  . 

1905.  . 

1906.  . 

Brooklyn 

1897.  . 

1898.  . 

1899.  . 

1900.  . 
1901  .   . 

1902.  . 

1903.  . 

1904.  . 

1905.  . 

1906.  . 

Queens 

1897.  - 

1898.  . 

1899.  . 

1900.  . 
1901  .  . 

1902.  . 

1903.  . 

1904.  . 

1905.  . 

1906.  . 

Richmond 

1897.  . 

1898.  . 

1899.  . 

1900.  . 
1901  .  . 

1902.  . 

1903.  . 
1904  .  . 

1905.  . 

1906.  . 


Pul. 
tub. 


Tub. 
men. 


5  -  10 


Pul. 
tub. 


Tub. 
men. 


10-15 


Pul. 
tub. 


Tub, 
men. 


Total  tinder  15 


Pul. 
tub. 


Tub. 
men. 


Total. 

both. 

under  15 


Deaths, 
both,  par 
1,000  of 
popula- 
tion 


Exhibit  4— Continued 


121 


Table  56 
TUBERCULOSIS    REGISTER:      LIVING    CASES,    1906 


Cases  enrolled  January  1,  1906 

Under  care  of  private  physicians 

Under  care  of  dispensaries  or  clinics* 

At  home  and  under  supervision  of  department. 

In  institutions  in  city   

In    institutions   outside   city 

Not  found  at  address  given;t  1904  and  1905 

New    (living)   cases  reported 

By    physicians    

By    sputum    

By    institutions 

Total  living  cases  enrolled  in  1906 

Cases  removed  from  register  in  1906 

Deaths    

Removals   from  city   

Not  found;!  held  for  2  years 

Recovered     

Cases   enrolled   December   31,   1906 

Under  care  of  private  physicians 

Under  care  of  dispensaries  or  clinics 

At  home  and  under  supervision  of  department. 

In   institutions  in  city 

In  institutions  outside  city 

Not  found  at  address  given;t  1905  and  1906.. 
Total    


Man- 
hattan 


Bronx 


Brook- [Queens    Rich- 
lyn     I  mond 


•Other  than  the  department  clinics 

tHeld  in  current  register  2  years;  after  that  time,  removed  to  files 


I( 


II 


122 


Exhibit  4 — Continued 


Table  57 

As  is  seen  in  Table  56,  cases  of  tuberculosis  are  classified  for  ad- 
ministrative purposes  in  six  groups.  The  cases  visited  by  the  inspectors 
may  be  found  in  almost  any  of  these:  no  exact  statement  is  made  of 
the  number  of  cases  which  they  might  be  expected  to  visit.  The  deter- 
mination of  whether  or  not  they  visit  all  the  cases  that  they  should  is 
for  the  present  a  matter  for  the  current  office  records. 

In  two  other  main  lines  of  the  division's  work,  however,  a  standard 
is  possible.  The  "at  home"  file,  which  contains  the  cases  on  which  the 
work  of  the  district  nurses  and  of  the  clinics  is  done,  is  capable  of  the 
same  form  of  statement  as  a  hospital — substituting  "at  home"  months 
for  patient  days.  If  10  patients  are  "at  home,"  one  for  2  months,  one 
for  3  months,  etc.,  a  total  of  50  months  for  all,  while  the  district  nurses 
keep  under  observation  during  that  time  one  patient  for  i  month,  one 
patient  for  2  months,  etc.,  a  total  of  15  months,  and  if  the  clinic  also 
has  under  treatment  patients  for  a  total  of  20  months,  then  30%  repre- 
sents the  proportion  of  the  "at  home"  field  covered  by  the  district 
nurses,  40%  the  proportion  covered  by  the  clinics,  and  70%  the  propor- 
tion covered  by  both.  It  is  quite  probable  that  it  is  unnecessary  to 
keep  the  entire  "at  home"  group  under  constant  observation  or  treat- 
ment. The  above  percentages,  however,  given  year  by  year,  would 
work  out  a  standard  on  the  basis  of  experience. 


Exhibit  4— Continued 


123 


Table  57 

SUMMARY    OF    DISTRICT    INSPECTION     OF    TUBERCULOSIS 

AND    OF 
TREATMENT    BY    THE    DEPARTMENT    CLINICS,    1906 


TOTAL  MONTHS  MX  "AT  HOM^"  CASES 

Months  "at  home"  cases  under  observation  by 
district  nurses 

Pero«ntair«  of  total  months 

Months    "at    home"    cases    under   treatment   or 
observation  by  department  clinics   

F«rc«ntair«  of  total  months 

Months  "at  home"  cases  under  observation  or 
treatment  by  both  district  nurses  and  clinics  .  .  . 

Fsrcontaffo  of  total  months  all  "at  homo" 
oasos 


New 
York 


Man- 
hattan 


Bronx 


Brook- 
lyn 


Queens 


Rich- 
mond 


X14 


Exhibit  4^Continued 


Table  38 

It  may  be  expected  that  the  numlDer  of  disinfections  ordered  will 
have  an  approximate  (though  only  an  approximate)  correspondence 
with  the  number  of  premises  visited  on  account  of  deaths  or  removals. 

The  average  frequency  of  visits  by  nurses  to  cases  under  observa- 
tion is  worked  out  in  the  same  form  as  that  employed  in  Table  57.  If 
as  is  expected,  they  visit  each  case  once  a  week,  the  average  visits  per 
month  per  case  under  observation  will  be  approximately  4. 


Table  39 

In  Table  59,  the  item,  "Old  cases  coming  under  treatment  in  1906," 
is  introduced  in  order  to  make  an  exact  balance  with  the  number  of 
dispositions  made  of  cases  given  immediately  below.  As  the  same  case 
may  be  sent  to  a  hospital  or  otherwise  disposed  of  several  times  during 
a  year,  it  is  necessary  to  provide  as  above  for  the  duplicate  entries. 
The  "total,"  therefore,  does  not  represent  the  number  of  different  per- 
sons under  treatment  during  the  year :  if  this  figure  is  desired,  it  can  be 
obtained  by  adding  the  items  "Under  treatment  January  i"  and  "New 
cases  coming  under  treatment  in  1906." 

The  average  frequency  of  clinic  treatment  and  of  visits  by  nurses 
to  cases  kept  under  observation  is  shown  by  means  of  the  same  form 
of  statement  as  is  employed  in  Table  57.  As  the  cases  kept  under  ob- 
servation by  the  nurses  are  expected  to  be  visited  once  a  week,  the  item 
"Average  visits  per  month  per  case  under  observation'*  will  pre- 
sumably be  found  to  be  about  4. 


Exhibit  4— Continued 


125 


Table  58 
TUBERCULOSIS:      DISTRICT    INSPECTION,    1906 


INSPECTORS 

Premises  visited  on  account  of 

deaths*    

Cases  removing  to  hospitalf 

Cases   removing   from  city t 

Cases  changing  address! 

Cases  "at  home"  visited  on  complaint 

Total    cases    inspected 

Visits   to  cases   inspected 

Visits  to  investigate  or  trace  cases 

Total    visits    by    inspectors 

NURSES 

Total  months  all  "at  home"  cases  nnder 
obserration  by  district  nurses 

Visits  to  cases  *'at  home"    nnder   obser- 
vation   

Averagre    visits    per   month    per  case  "at 
home"  under  observation 

Visits  to  investigate   or  trace  cases 

Total  visits  by  district  nurses 

DISPOSITION  OF  CASES 

Forcible   removals   to   hospital 

References  of  cases  to  hospitals 

References  of  cases  to  charitable  organizations. 
Renovations  compelled  by  inspectors'  complaints 

Renovations  made  voluntarily 

Disinfections    of    premises    ordered 

Disinfections    of   goods    ordered 


New 

York 


Man- 
hattan 


Bronx 


Brook- 
lyn 


Queens 


Rich- 
mond 


1 


•From  any  one  of  several  files,  or  not  previously   reported 
tFrom  any  one  of  several  filet 


'  I    ; 


i 


I'll 


126 


Exhibit  4 — Continued 


Table  59 


TUBERCULOSIS    CLINICS,  1906 


New 
York 


DIAGNOSIS 

Under  observation  for  diagnosis  Jan.  1,  1908.. 

New  patients  examined  during  1906 

Total    

Found  not  tubercular  and  transferr-d  or  dis- 
charged      

Found    tubercular    

Diagnosis  tubercular,  sputum  positive 

Diagnosis  tubercular,   sputum  negative 

Under  observation  for  diagnosis  Dec.  81,  1906.. 

Total    

CASES  UNDER  TREATMENT 

Under    treatment    Jan.    1,    1906 

New  cases  coming  under  treatment  in  1906 .... 
Old  cases  coming  under  treatment  in  1906 .... 
Total    


Man- 
hattan 


Bronx 


Deaths     

Transferred   to    other   clinics 

Transferred    to    hospitals 

Transferred    to    sanatoria 

Discontinuing,    not    found 

Discontinuing,  not  coming  for  treatment. 

Under  treatment  Dec.  31,  1906 

Total    


Total  months  all  paticnta  under  traatmant 

by  clinics 

Total  treatments  of  patients 

Average  treatments  per  month  per  patient 

Largest  number  of  patients  in  1  day 

Smallest  number  of  patients  in  1  day 

Average  number  of  patients  in  1  day 

VISITS  TO  CASES 
Total  months  all  patients  nnder  ohserva- 

tion  by  clinio  nurses 

▼isits  to  patients  under  observation  .... 
▲verag'e  visits  per  month  per  case  under 

observation 

Other  visits  to  cases  under  clinic  treatment.... 

Total  visits  by  clinic  nurses 

Visits  by  clinic  physicians 


MISCELLANEOUS 

Prescriptions  filled  for  clinic  patients 

Quarts  of  milk  supplied  to  clinic  patients. 
Eggs  supplied  to  clinic  patients 


Brook- 
lyn 


Exhibit  4 — Continued 


127 


Table  60 


DIPHTHERIA:  GENERAL  FIGURES,    1897-1906 


Year 


Mew  York 

1897.  . 

1898.  . 

1899.  . 

1900.  . 
1901  .  . 

1902.  . 

1903.  . 

1904.  . 

1905.  . 

1906.  . 


Manhattan 

1897.  . 

1898.  . 

1899.  • 

1900.  . 

1901.  . 

1902.  . 

1903.  . 

1904.  . 

1905.  . 

1906.  . 


Cases 
reported 


Bronx 
1897 
1898 
1899 
1900 
1901 
1902 
1903 
1904 
1905 
1906 


Brooklyn 
1897. 
1898. 
1899. 
1900. 
1901. 
1902. 
1903. 
1904. 
1905. 
1906. 


Queens 

1897 
1898 
1899 
1900 
1901 
1902 
1903 
1904 
1905 
1906 


Cases  per 

1,000  of 

population 


Richmond 
1897.  . 
189S.  . 

1899.  . 

1900.  . 

1901  .  . 

1902  .  . 

1903.  . 

1904.  . 

1905.  . 

1906.  . 


Deaths 


population  \  p^^  cent. 


Deaths 
per  1,000  of 


Case 

fatality 


Per  cent,  of 

cases  reported, 

iaj acted 

at  home  by 
dept.  of  health 


I 


128 


Exhihii  4— Continued 


Table  61 


DIPHTHERIA:    INJECTION,  INTUBATION,  AND  IMMUNIZATION,  1906* 


INJECTION  OF  ANTITOXIN 

Cases    of    diphtheria    reported 

Cases  injected  by  dept.  inspectors 

Percentage  iajeoted  by  dept.  ixispectorfl  .  . 

Cases  injected  by  private  physiciansf 

Peroentair*  iajeoted  by  private  phyalolans 

By  department  inspectors 

Cases    injected 

Deaths     

Case  fatality,  per  cent 

Deaths,    moribund^     deducted 

Case  fatality,  per  cent.,  moribund  %  de- 
ducted  

By   private  physiciansf    

Cases    injected 

Deaths     

Case  fatality,  per  cent 

Deaths,    moribund^    deducted 

Case  fatality,  per  cent.,  moribund  %  de- 
ducted . , 

INTUBATION  OF  LARYNGEAL  CASES 

Cases    injected    by    dept.    inspectors 

Total   laryngeal   cases 

Deaths 

Fatality    per    cent 

Cases    intubated 

Deaths     

Fatality    per    cent 

Cases    not   intubated 

Deaths     

Fatality    per    cent 

IMMUNIZATION 

By   department  inspectors 

Number     immunized 

Number  contracting  disease  between  8  and  80 
days     

VISITS 

Total  visits  to  diphtheria  cases 

Average   visits   per    case 

Total    injections 


New 
York 


Man- 
hattan 


Bronx 


Brook- 
lyn 


Queens 


Rich- 
mond 


Exhibit   4 — Continued 


129 


Table  62 

TYPHOID  AND  CEREBRO-SPINAL  MENINGITIS: 

GENERAL  FIGURES.    1897-1906 
New  York  City:  cases  reported,  case  rate,  and  death  rate 


•Quarantine  is  maintained  and  disinfections  are  ordered  by  the  division  of  contagiouA  diaeases 
tWith  antitoxin  furnished  free  by  the  department^  of  health 
tCases  dying  within  24  hours  after  injection 


Typhoid 

1897 

1898 

1899 

1900 

1901 

1902 

1903 

1904 

1905 

1906 

Cerebro-spinal  meningitis 

1897 

1898 

1899 

1900 

1901 

1902 

1903 

1904 

1905 

1906 


Cases  reported 


Cases  per 

1,000 

of  population 


Deaths 


Deaths  per 

1,000 

of  population 


I30 


Exhibit  4 — Continued 


Table  63 


TYPHOID  FEVER:     GENERAL  FIGURES  AND  INSPECTION,  1906 


Cases   reported    

Oases  per  1,000  of  popnlation 

Deaths   from   typhoid 

Case  fktallty,  per  cent 

Deatlis  per  1,000  of  population 

Cases  not  inspected  on  account  of  detailed  re- 
port by  attending  physician 

Cases   inspected    

Total     •..-...•• 

Visits  to  cases 

Disinfections   of   goods   ordered 


New 
York 

Man- 
hattan 

Bronx 

Brook- 
lyn 

Queens 

• 

Rich- 
mond 


Table  64 

CEREBRO-SPINAL  MENINGITIS:     GENERAL  FIGURES  AND  INSPEC- 
TION,  1906 


Cases      reported 

Cases  per  1,000  of  population  .  .  . 

Deaths    

Case  fatality,  per  cent 

Deaths  per  1,000  of  population 

Cases   visited    

Visits  to  cases 

Disinfections    of   premises    ordered . . . 
Disinfections    of  goods    ordered 


New 
York 


Man- 
hattan 


Bronx 


Brook- 
lyn 


Queens 


Rich- 
mond 


Exhibit  ^—Continued 


131 


Table  6$ 
SUMMARY  OF  INSPECTIONS,  VISITS,  ETC.,  DIVISION  OF  COMMUNICABLE 

DISEASES,    1905-1906 


Tuberculosis 

Diphtheria 

Typhoid 

Cerebro-spinal  meningitis 

Malarial  fever 

Pneumonia 

Brysipelas 

Puerperal  septicaemia   . 

Other  

Total 


Cases  visited 


1905 


1906 


Visits  to  cases 


Inspectors 


1905 


1906 


Nurses 


1905 


1906 


Disinfections 
ordered,  1906 


Premises!  Goods 


Re- 
movals 
to  hos- 
pitals, 

1906 


A 


132 


Exhibit  4— Continued 


Table  66 


DIAGNOSIS     LABORATORY:     SPECIMENS     EXAMINED    AND 
RESULTS    OF    EXAMINATION,    1906 


DIPHTHERIA 

Bacteriological   examinations   for   diaKnosis 

Showing   Klebs-Loc£fler   bacilli , 

Not  showing  Klebs-Loeffler  bacilli , 

Indecisive     

Later    cultures 

Other   cultures 

Total    cultures    

TUBERCULOSIS.  SPUTUM 

Specimens    examined    

Showing   tubercle  bacilli    

Showing  no   tubercle  bacilli   ........... 

TYPHOID 

Widal  Reaction 

Specimens  of  blood  examined 

Showing    reaction    

Showing   no   reaction    

Indecisive     

Diazo  Reaction 

Specimens  examined 

Showing  diazo  reaction 

Showing  no  diazo  reaction 

Showing    doubtful    reaction 

MALARIA 

Specimens  examined   

Showing   malaria   plas    

Showing  no  malaria  plas 

MISCELLANEOUS 

Average  number  of  culture   stations* 

Visits  to  collect  specimens 

Culture    tubes    prepared 

Swabs   made    

Laboratory  preparations  made 


New 
York 


Man- 
hattan 


Bronx 


Brook- 
lyn 


Queens 


Rich- 
mond 


Exhibit  4 — Continued 


133 


Table  67 

DIAGNOSIS    LABORATORY;      SPECIMENS    SUBMITTED 

FOR  EXAMINATION,    1906 


Diphtheria  .... 

Tuberculosis  •  .  . 

Typhoid 

Widal  reaction 
Diazo  reaction 

Malaria 

Total 

Percentage .... 


Number  of  specimens  submitted  for  diagnosis  by 


Department  of  health 


Private  physicians 


'Average  of  those  in  operation  on  the  first  of  each  month 


134 


Exhibit  4 — Continued 


Objects 


Activities 


Relation  of 

Activities 
to  Object 


HOSPITALS   FOR  GENERAL  INFECTIOUS 

DISEASES 

(a)  Preventive.  To  remove  cases  of  contagious 
diseases  from  the  imperfect  quarantine  of  a  home  to 
the  relatively  perfect  isolation  of  a  hospital. 

(b)  Curative.    To  provide  treatment. 

The  proper  treatment  and  disposition  of  the  cases 
received. 

The  contribution  of  a  contagious  disease  hospital 
to  prevention  can  be  measured  only  when  some 
change  of  policy  occurs  in  committing  cases  to  the 
hospitals.  For  example,  if  the  scarlet  fever  pavilion 
at  Willard  Parker  hospital  is  enabled  to  receive  a 
much  larger  percentage  than  formerly  of  the  cases  oc- 
curring in  Manhattan,  it  will  be  fair  to  expect  the 
prevalence  and  death  rate  of  that  disease  to  fall  off 
perceptibly  in  the  next  five  years. 

Improved  methods  of  treatment,  such  as  that  of 
diphtheria  by  antitoxin,  show  in  a  decreased  case  fa- 
tality over  a  series  of  years. 


Table  68 

Table  6S  indicates  what  proportion  of  the  total  cases  of  contagious 
diseases  reported  the  department  cares  for  in  its  hospitals.  The  open- 
ing of  a  new  ward  or  pavilion  is  reflected  in  the  increased  proportion  of 
cases  cared  for,  and  gives  a  basis  for  judging  the  contribution  of  the 
hospitals  to  the  prevention  of  disease. 


Exhibit  4— Continued 


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135 


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136 


Exhibit  4—Oontint^cl 


Tobies  69-84 

Table  69  summarizes  Tables  70-74,  which  are  practically  the  present 
forms  of  statement  of  patients  received  and  discharged. 

Tables  75-79  show  the  high  and  low  extremes  of  demand  for  hospital 
care;  also  the  average  number  of  patients  for  each  of  five  hospitals. 

Tables  80-83  give  for  each  hospital  (except  Otisville,  for  which  it 
would  be  without  significance)  the  case  fatality  by  age  periods,  accord- 
ing to  the  duration  of  the  disease  previous  to  admission.  It  may  be 
expected  that  the  figures  will  prove  a  lower  fatality  in  cases  of  early 
admission. 

Table  84  is  intended  to  show  to  what  extent  the  hospitals  may  be 
responsible  for  infections  among  patients  after  admission. 


Exhibit  4— Continued 


137 


Table  69 

ALL    DEPARTMENT    OF    HEALTH    HOSPITALS:    PATIENTS 

DURING    1906 


Diphtheria    

Scarlet  fever  

Small-pox     

Chicken-pox ....•• 

Measles     * •  • . 

Mumps    

Tuberculosis     

German    measles    

Whooping   cough    

Diphtheria  and   scarlet   fever 

Diphtheria    and    chicken-pox 

Diphtheria  and  measles 

Diphtheria  and  German  measles 

Diphtheria  and  whooping  couRh 

Diphtheria,   scarlet   fever,    and   measles 

Scarlet  fever  and  whooping  couch 

Measles    and    chicken-pox 

Measles  and  whooping  cough 

Gonorrheal  vaginitis  complicating  other  diseases. 

Trachoma     

Total  cases    

For  observation 

Persons  accompansring  patient  


?3 
rS. 

t 

B 

So 

1^ 

0 
0 

3- 
(0 

t 

0 

2: 

» 

• 

0» 
PS 

2. 
5* 


f 


I 


I 

I 


II 


138 


Exhibit  4~'Continued 

Tables  70-74* 
HOSPlTALt:    PATIENTS  DURING   1906 


Diphtheria 

Scarlet  fever 

Small-i>ox 

Chicken-pox 

Measles 

Mumps 

Tuberculosis 

Oerman  measles 

"Whoopingr  cough 

Diphtheria  and  scarlet  fever 

Diphtheria  and  chicken-pox 

Diphtheria  and  measles 

Diphtheria  and  German  measles .  .  . 

Diphtheria  and  whooping:  cough  .  .  . 

Diphtheria,  scarlet  fever,  and  measles 

Scarlet  fever  and  whooping  cough  . . 

Measles  and  chicken-pox 

Measles  and  whooping  cough  .... 

Gonorrheal   vaginitis   complicating 
other  diseases 

Total  cases 

For  observation 

Accompanying 


Remain- 
ing 
Jan.  1, 
1906 


Admitted 


New 


Trans- 


ToUl 


ferred  ^'^^'^^ 
from 


Dis- 
charged 


Died 


Trans- 
ferred 
to 


Remain- 
ing 

Dec.  31, 
1906 


Exhibit  4— Continued 


139 


♦One  each  for  Reception,  Willard  Parker,  Riverside,  Kingston  Avenue,  and  Otisville 
t  Only  the  diseases  treated  in  each  hospital  being  given  in  the  first  column 


Tables  73-79* 
HOSPITAL:    SERVICE  RENDERED,    1906! 


Patients 


Fatl«nt 
days 


Diphtheria  .  .  .  . 
Scarlet  fever  .  .  . 

Small-pox 

Chicken-pox  .  .  . 

Measles 

German  measles 
Whooping  cough. 

Mumps 

Tuberculosis  .  . 
Mixed  infections. 
Total 

For  observation . 
Accompanying  .  . 


•One  each  for  Reception,  Willard  Parker,  Riverside,  Kingston  Avenue,  and  Otisville 
t  Only  the  disease  treated  in  each  hospital  being  given  in  the  first  column 


Average 

days  per 

patient 


Largest 

number 

patients  at 

one  time 


Smallest 

number 

patients  at 

one  time 


Average 

patients 
per  day 


• 

S3 

i 

1 

s? 

I 


8 


J?* 
o 


n 

5' 

c 


o. 

3 

S* 

m 
0* 

a 


140 


Exhibit  4^Continufd 


Table  84 
CASES    OF   INFECTION    WITHIN    HOSPITALS,    1906 


Cases    of    measles    developing    more    than    14 
days   after  admission    

Cases  of  scarlet  ferer  developing  more  than  10 
days  after   admission    


Reception 


Willard 
Parker 


Riverside    Kingston 
Kiversiae  i    Avenue 


Exhibit  4 — Continued 


141 


Table  8j 

OTISVILLE  SANATORIUM:     PATIENTS  TREATED  AND  CONDITION    WHEN 

DISCHARGED*    1906 


NUMBER 

Incipient 

Moderately  advanced 
Far  advanced   .... 


P«re«ntaff« 

Incipient 

Moderately  advanced 
Far  advanced   .... 


Total 

cases 

treated 

in  1906 

Discharged 

Deaths 

Appar- 
ently 
cured 

Arrested 

Im- 
proved 

Progres- 
sive 

100 
100 
100 

Under 
treat- 
ment 
Dec.  31 


*  The  classification  as  to  stage  of  disease,  etc.,  is  that  adopted  by  the    National    Association 
lor  the  Study  and  Prevention  of   Tuberculosis 


Table  86 
OTISVILLE  SANATORIUM  :     DURATION  OF  PATIENTS'   STAY,    1906 


Total  patients  discharged,    1906 

Length  of  stay , 

Under  1  month 

Over  I   month  and  under  3  months. 

Over  3  months  and  under  6  months. 

Over   6  months 


TabU  87 

OTISVILLE  SANATORIUM:    PLACES  TO  WHICH  PATIENTS 

DISCHARGED,    1906 


Per  cent. 


Totel  fwtieBtt  discharged,   1906 

Patients  discharged  to  their  homes 

"  «         M    pji,^,    sanitoria... 

•  ••         ..    ^ork  at  OtisviUe. 


Number 


F«reMit. 


142 


Object 


Activities 


Relation  of 
Activities 
to  Object 


Exhibit  4— Continued 


TRACHOMA  HOSPITAL  AND  DISPENSARIES 

To  cure  cases  of  trachoma  and  other  contagious  eye 
diseases,  chiefly  among  school  children,  and  thereby 
to  diminish  their  prevalence. 

Furnishing  treatment  (operative,  post-operative,  and 
non-operative)  to  the  cases  referred  to  it. 

The  contribution  of  the  hospital  toward  diminish- 
ing the  prevalence  of  trachoma  and  other  contagious 
eye  diseases  among  school  children  cannot  be  sharply 
distinguished  from  that  of  the  medical  inspectors  of 
schools  and  school  nurses  in  discovering  cases  and 
urging  treatment.  The  prevalence  of  trachoma  and 
other  contagious  eye  diseases  given  in  Table  36  should 
show  by  its  gradual  decrease  in  a  series  of  years  the 
success  of  the  combined  work  of  the  hospital,  med- 
ical inspectors,  and  nurses.  The  direct  cures  of  the 
hospital  can  be  indicated  by  the  percentage  discharged 
apparently  cured  (Table  88),  and  by  a  special  subse- 
quent investigation  of  these  cases  to  discover  the  per- 
centage of  permanent  cures  (Table  89). 


Exhibit  4 — Continued 


143 


TabU  88 

TRACHOMA  HOSPITAL  AND  DISPENSARIES:     NUMBER  AND 
PERCENTAGE  OF  APPARENT  CURES,   1902-1906 


CASES  TREATED 

Trachoma :    operative 

Trachoma :    non-operative 

Other  contagious  eye  diseases 

DISCHARGED  APPARENTLY  CURED 

Trachoma :    operative 

Trachoma:    non-operative , 

Other  contagious  eye  diseases 

Peroantage  of  those  treated  discharged  ap. 
pareutly  otired 

Trachoma  :    operative 

Trachoma  :    non-operative 

Other  contagriona  eye  diseases 


1902 


1903 


1904 


1905 


1906 


Table  8g 

TRACHOMA  HOSPITAL  AND  DISPENSARIES:    SPECIAL  ANNUAL 

INVESTIGATION 

Number  and  percentage  of  permanent  cures  among  patients  discharged  during  1906;    investigation 

made  (dates  of  duration) 


Discharged  apparently  cured 

Investigated  

Found  

No   relapse 

Percentage  no  relapse  to  those  found 

Same  percentage,  previous  investigation 


Trachoma 


Operative 


Non-operative 


144 


Eahibit  4— Continued 


Table  ^ 

TRACHOMA  HOSPITAL  AND  DISPENSARIES:    TREATMENT  AND 

DISPOSITION  OF  CASES,  1906 


CASES  TREATED 

Under  treatment  January  i,  1906. 

New  cases  treated  in  1 906 

Total  treated  in  1906 


DISPOSITION 

Discharged  apparently  curedf 

Discontinuing  before  cure} 

Under  treatment  December  31,  1906. 
Total  


Trachoma 


By  opera- 
tion* 


Non-opera- 
tive only 


F«rc«xitaff«   of  thoa*  treated    diseliarffed 
apparently  onred 


Other  conta- 
gious   eye 
diseuset 


Total 


t 
X 


•With  post-operative  treatment  following 

tit  is  suggested  that  no  totals  be  entered  for  these    items,    since    by    combining    several    unlike 
quantities  a  false  conclusion  might  be  drawn 

iA   patient    is    considered   as    "discontinuing"    when  he  does  not  appear  for  2  months 


Exhibit  4— Continued 


145 


Table  91 

TRACHOMA    HOSPITAL    AND    DISPENSARIES:    EXAMINATIONS. 

DIAGNOSES,  AND  TREATMENTS,  1906 


EXAMINATIONS 

Examinations   for   diagnosis. 


DIAGNOSES 

Cases  rejected  as  non-contagious 

Cases   found :   trachoma 

Cases  found:  other  contagious  eye  diseases. 
Total  


TREATMENTS 

Trachoma:    operations 

Trachoma :   post-operative 

Trachoma :    non-operative 

Other  contagious  eye  diseases. 

Totol  

Largest  number  in  one  day... 
Average  number  per  day 


Hospital 


Dispensaries 


Total 


146 


Object 


Activities 


Relation  of 
Activities 
to  Object 


Exhibit  4— Continued 


RESEARCH   LABORATORY 

With  the  exception  of  the  administration  of  Pas- 
teur treatment,  the  research  laboratory  conducts  a 
subsidiary  line  of  work,  and  therefore  has  no  direct 
health  object. 

(a)  Special  bacteriological  investigations. 

(b)  Production  of  antitoxic  serums  and  diagnostic 
toxins. 

(c)  Bacteriological  examination  of  specimens. 

(d)  Administration  of  Pasteur  treatment. 

The  result  of  the  work  under  (a)  is  shown  in  the 
special  reports  of  investigations.  For  (b)  and  (c) 
there  is  a  formal  report  of  amounts  produced  and  of 
specimens  examined  (Tables  92-93).  (d)  In  judg- 
ing of  the  Pasteur  treatment,  as  of  the  department's 
immunization  by  antitoxin  injection,  it  is  of  course 
impossible  to  know  how  many  persons  would  have 
contracted  the  disease  if  treatment  had  not  been  ad- 
ministered. All  that  can  be  stated  is  the  number  of 
persons  treated  and  the  number  developing  hydro- 
phobia  (Table  94). 


Exhibit  4 — Continued 


147 


Table  92 

RESEARCH    LABORATORY:      PRODUCTION   OF   ANTITOXIC   SERUMS  AND 

DIAGNOSTIC  TOXINS,    1905- 1906 


Units  of  diphtheria  antitoxin  produced  (in  thousands) 

Units  of  diphtheria  antitoxin  bottled  for  distribution(in  thousands) 
Cubic  centimeters  of  diphtheria  toxin  produced 

Units  of  tetanus  antitoxin  produced  (in  thousands)  ......... 

Units  of  tetanus  antitoxin  bottled  for  distribution  (in  thousands)  . 
Cubic  centimeters  of  tetanus  toxin  produced 

Cubic  centimeters  of  mallein  produced 

Cubic  centimeters  of  mallein  bottled  for  distribution 

Cubic  centimeters  of  tuberculin  produced 

Cubic  centimeters  of  tuberculin  bottled  for  distribution 

Samples  of  toxins  tested 

Samples  of  antitoxin  serum  tested 


1905 


1906 


Table  93 

RESEARCH  LABORATORY:    BACTERIOLOGICAL  EXAMINATION   OF 

SPECIMENvS,    1905-1906 


Bacteriological  examinations  of  water 

Bacteriolosrical  examinations  of  milk 

Bacteriological  examinations  for  virulence  of  diphtheria  bacilli. 


1905 


1906 


Table  94 
RESEARCH  LABORATORY :  PASTEUR  TREATMENT,  1905-1906 


Patients  under  treatment  Jan.  1 

Patients  under  observation  Jan.  1  * 

New  patients  treated  during  year 

Living:  in  New  York  City  t 

Living  outside  of  New  York  City  X     .  •  •  . 
Attending  laboratory  for  treatment 

Receiving  vaccine  by  mail 

Total 


Patients  developing  hydrophobia  .   .  . 
Patients  not  developing  hydrophobia 
Patients  under  treatment  Dec.  31   .   . 
Patients  under  observation  Dec.  31  • 
Total 


Number  of  injections  in  patients 
Animals  diagnosed  for  rabies  .  . 

Cases  

Not  cases 


1905 


1906 


*  Patients  kept  under  observation  for  one  month  after  close  of  treatment 
t  Free 
Paying 


liS 


Exhibit  '4^Coniinu^d 


Exhihii  4— Continued 


149 


Object 
Activities 


Relation  of 
Activities 
to  Object 


CHEMICAL    LABORATORY 

As  the  chemical  laboratory  is  a  subsidiary  line  of 
work,  no  direct  health  object  can  be  stated. 

Analysis  of  and  report  upon  the  specimens  submit- 
ted to  it. 

As  there  is  no  direct  health  object,  nothing  remains 
but  to  present  a  statement  of  the  specimens  submit- 
ted, so  classified  as  to  show  by  whom  submitted 
(Table  95)  and  the  results  of  analysis  (Table  96).  A 
statement  is  therefore  added  of  the  number  of  half 
days  consumed  in  attendance  at  court  for  the  purpose 
of  testifying  (Table  97). 


Table  95 
CHEMICAL    LABORATORY:  SPECIMENS  SUBMITTED  AND  ANALYZED,  1906 


Total  number  of  specimens  analyzed 
Total  number  pieces  of  apparatus  tested 
Total  number  reports  forwarded  and  filed 


Specimens  submitted  .  .  .  . 
By  department  of  health 

Acetanelid 

Air 

Etc 

Total 


By  police  department 

Beer 

Opium 

Chloral 

Etc 

Total 


By  department  of  water  supply 
Water 


By  department  of  street  cleaning: 

Garbage 

Ash 

Etc 

Total , 


By  Bellevue  hospital  .  .  .  . 
By  department  of  finance  .  . 
By  department  of  correction 

By  coroner 

By  district  attorney 

By  county  medical  society  .  • 


1905 


1906 


O 


Table  g6 

CHEMICA.L  LABORATORY:    RESULTS  OF  ANALYSES,  1906 
The  results  of  analyses  may  be  siven  as  they  are,  at  lengrth,  in  the  annual  report  for  1905 

Table  97 

CHEMICAL  LABORATORY  :  NUMBER  OF  HALF  DAYS  OF  ATTENDANCE 

AT  COURT,  1905-1906 

1905  I  1906 


January  .  . 
February  " 
March  •  .  . 
April .  .  . 
May.  .   .  . 
June  .  .  .  . 
Jnly.  .  .  . 
Auffust  •  • 
September 
October  .  . 
November 
December . 
Total.  .  . 


I50 


Object 


Activities 


Relation  of 
Activities 
to  Object 


Exhibit  4 — Continued     * 


VACCINE    LABORATORY 

Like  the  other  laboratories,  the  vaccine  labora- 
tory is  a  subsidiary  line  of  work  and  has  no  direct 
health  object. 

(a)  Production  of  vaccine  virus. 

(b)  Experimental  testing  of  vaccine  virus  pro- 
duced. 

(c)  Issuance,    mainly   to   the   chief   clerk   and    to 

hospitals,  of  the  virus  as  prepared  for  use. 

A  formal  statement  is  given  of  the  amount  of  virus 
produced,  tested,  and  issued. 


%. 


Exhibit  4 — Continued 

Table  p8 

VACCINE    LABORATORY:    VIRUS  PRODUCED,  TESTED,  AND  ISSUED 

1905-1906 


I5» 


PRODUCTION  OF  VACCINE  VIRUS 
Gram  collected 

Cubic  centimeters  of  liquid  virus 
prepared  

Spades    charged    with     human- 
ized   virus 

EXPERIMENTAL     TESTING    OF 
VIRUS 

Primary  vaccinations 

Secondary  vaccinations 

Visits 

MISCELLANEOUS 

Specimens  of  virus  tested  bacter- 
iolosrically 

Inspections    of  virus  previously 
sold 

Animals  vaccinated 

Animals  collected  from  .... 

Autopsies  on  animals 

White  mice  injected 

other  animals  experimentedupon 

Mailing  blocks  prepared .... 


VACCINE  VIRUS  ISSUED 
Capillary  tubes   .... 

Small  vials 

Large   vials 


1905 


1906 


To 
chief 


To 


cicT^     hospitals 


To 
miscel- 
laneous 


In 

exchange 

for  old 

virus 


Total 

1906 


ToUl 

1905 


152 


Exhibit  4 — Continued 


REMOVAI.  OF  DEAD  ANIMALS,   OFFAL,   AND  NIGHT  SOIL 

The  removal  of  dead  animals,  oifal,  and  night  soil  is  done  by 
contract,  the  contracts  now  in  force  being  for  five  years.  When 
an  order  to  remove  a  carcase  is  forwarded  to  the  contractors, 
the  department,  it  is  stated,  keeps  pressure  upon  the  contractor  till  he 
reports  the  order  executed.  Relying  upon  the  likelihood  of  other  com- 
plaints from  citizens  if  the  order  remains  unexecuted,  the  department 
feels  reasonably  assured  that  the  orders  to  remove  are  actually  carried 
out. 

As  to  the  other  question,  whether  the  removals  (or  trips  for  the 
purpose  of  removal)  agree  in  number  with  the  removals  ordered,  no  at- 
tempt is  made  to  determine.  Carcases  may  be  reported  for  removal  to 
the  contractors,  either  through  the  department  headquarters  or  directly. 
The  telephone  number  of  the  offal  dock  is  in  the  telephone  directory  and 
there  is  nothing  to  prevent  any  citizen  from  communicating  directly  with 
the  contractors,  without  the  knowledge  of  the  department.  The  only 
source  of  information,  therefore,  as  to  the  amount  of  service  ren- 
dered, is  in  the  uncontrolled  reports  of  the  contractors. 

It  is  urged  that  the  only  way  of  furnishing  data  which  would 
serve  as  an  approximately  reliable  basis  for  bids,  is  to  require  all  removal 
orders  to  go  through  the  department  office  and  to  be  there  recorded, 
with  the  names  and  addresses  of  the  citizens  making  the  complaints, 
or  of  the  inspectors  ordering  removal.  The  contents  of  the  scows  main- 
tained for  the  reception  of  night  soil  can  be  inspected  and  estimated 
before  each  trip.  These  records,  when  summarized  and  published  an- 
nually, would  provide  facts  on  which  a  possible  future  bidder  could  base 
his  estimate.    (Table  99). 


.V 


Exhibit  4^  Continued 


153 


Table  pp 


DEAD  ANIMALS.  OFFAL,  AND  NIGHT  SOIL  ORDERED  REMOVED,  1906 


CARCASES  ORDERED  REMOVED 

Large  animals 

Horses  "^ 
Mules  I 
Donkeys  j 

Colts         I 

Ponies      ) 

Cattle 

Other  larsre  animals 

Total  large  animals 

Small  animals 

Calves 

Sheep       I 

Goats        ( 

Hogs         1 

PiKS  } 

Cats  and  dogs  from  streets 

Cats  and  dogs  from  public  pound  .  .  .  .  . 

Other  small  animals 

Total  small  animals 

Total  all  animals 

Greatest  number  any  one  week 

Large  animals 

Small         '*        

Smallest  number  any  one  week 

Large  animals 

Small         "        

QUANTITY  OF  MEAT,  OFFAL,  ETC,  ORDERED 
REMOVED 

Pounds  of  meat 

*»  »*  «. 

poultry 

rabbits 

"fish 

"  offal 

Total  pounds 

Number  of  removals  ordered  of  meat,  offal,  etc. 
Average  pounds  per  removal 

Greatest  number  of  pounds  any  one  week    .  . 
Smallest  number  of  pounds  any  one  week   .  . 

QUANTITY  OF  NIGHT  SOIL  REMOVED 

Cubic  yards  of  night  soil  removed 


New 
York 


Man- 
hattan 


Bronx 


Brook- 
lyn 


Queens 


Rich- 
mond 


154 


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156 


Exhibit  6 


PROPOSED  DETAILED  CLASSIFICATION  OF  EXPENDITURES 

MADE  BY  THE  DEPARTMENT  OF  HEALTH  TO  BE 

SHOWN   BY  THE  SEGREGATION  LEDGER 

I.    GENERAL  ADMINISTRATION 

1.  Commissioner 

Salaries  and  Wages 

Administrative  Head 

Assistants 

Clerks 

Stenographers 

Office  Boys 

Messengers 

Drivers 

Office  and  Other  Expenses 
Expressage 
Books  and  Periodicals 
Furniture  and  Fittings 
Supplies 

Horse  and  Carriage  Hire 
Auto  Service 
Transportation 
Traveling  Expenses 

2.  Secretary  Board  of  Health 

Office  of  Secretary 

Salaries  and  Wages  }  ^  .,.      »« 

r^cc  1  r\.\.     r-  ( ^^^  outline  for  commissioner 

Umce  and  Other  Expenses   J 


Exhibit  6 — Continued  157 

Other  Expenses 
Transportation 
Drawing  Materials 
Supplies 

Sale  of  Anti-toxin  and  Virus 
Salaries  and  Wages 
Clerks 
Collectors 

Other  Expenses 
Carfare 
Expressage 
Supplies 

EXHIBIT  6b 

3.  General  Medical  Officer 

Salaries  and  Wages 

Office  and  Other  Expenses 

4.  Sanitary  Superintendent 

Office  of  Sanitary  Superintendent 

Salaries  and  Wages  ) «         .i-      r 

r\cc         A  r\.A      V-  \  ^^^  outline  for  commissioner 

Office  and  Other  Expenses  \ 

Office  Chief  of  Communicable  Diseases 

Salaries  and  Wages  )  c-  i-      r 

r\aL         J  r^^u     >-  >  *^^^  outline  for  commissioner 

Office  and  Other  Expenses  J 

Office  of  Superintendent  of  Hospitals 


1 


See  outline  for  commissioner 


1 


) 
1 


See  outline  for  commissioner 


See  outline  for  commissioner 


Office  of  Chief  Clerk 
Office  Force 

Salaries  and  Wages 


) 


Office  and  Other  Expenses  j 

Construction  and  Repairs 
Salaries  and  Wages 
Inspector  in  Charge 
Inspectors 


-  See  outline  for  commissioner 


Salaries  and  Wages 
Office  and  Other  Expenses 

5.  Registrar  of  Records 

Salaries  and  Wages 
Office  and  Other  Expenses 

6.  Corporation  Counsel 

Salaries  and  Wages 
Office  and  Other  Expenses 

II.  BOROUGH  OFFICES  (The  below  given  outline  for  each  office  will 

be  used  for  the  corresponding  office  in 
each  borough) 
I.  Assistant  Chief  Clerk 

Office  force 

Salaries  and  Wages  )^  ,.      r 

r\ca  1  r^.l-     r-  iiiutt  outliuc  for  coiiimissioner 

Office  and  Other  Expenses   ) 


See  outline  for  commissioner 


I 


158 


Exhibit  6— Continued 


JExhibit  6— Continued 


159 


Care  and  Maintenance  of  Buildings 
Salaries  and  W«ges 
Janitor 
Engineer 
Watchman 
Laborers  and  Cleaners 

Repairs 

Building 

Plumbing 

Elevator 
Painting  and  Kalsomining 

Supplies 
Coal 

Engineers'  Supplies 
Janitors'  Supplies 

EXHIBIT  6c 

Undistributed  Expenditure 

Postage 

Telephone 

Switch  Board  Operators 

2.  Assistant  Sanitary  Superintendent 

Executive  Division 

Salaries  and  Wages  )  ^^^  outline  for  commissioner 

Office  and  Other  Expenses  J 

Division  of  Inspections 
Executive  Work 


Salaries  and  Wages 
Office  and  Other  Expenses 
General  Sanitary  Inspection 
Salaries 
Incidentals 
Carfare 
Telephone 
Supplies 

Milk  Inspection 
City 
Salaries 
Incidentals 
Carfare 
Telephone 
Supplies 


.  See  outline  for  commissioner 


i   1 


Country  ' 

Salaries 
Incidentals 

Carfare 

Telephone 

Supplies 

Food  Inspection 

Salaries 
Incidentals 

Carfare 

Telephone 

Supplies 

Division  of  Contagious  Diseases 

Executive  Work 
Salaries  and  Wages 
Office  and  Other  Expenses 

District  Medical  Inspection 

Inspectors 
Salaries 
Incidentals 

Carfare 

Telephone 

Supplies 

Nurses 

Salaries 
Incidentals 

Carfare 

Telephone 

Supplies 


! 


See  outline  for  commissioner 


EXHIBIT  6d 


Animal  Inspection 

Salaries 
Incidentals 
Carfare 
Telephone 
Supplies 


i6o 


Exhibit  6 — Continued 


!i  i 


School  Inspection 
Inspectors 
Salaries 
Incidentals 
Carfare 
Telephone 
Supplies 

Nurses 

Salaries 
Incidentals 

Carfare 

Telephone 

Supplies 

Summer  Corps 
Inspectors 
Salaries 
Incidentals 
Carfare 
Telephone 
Supplies 

Nurses 

Salaries 
Incidentals 

Carfare 

Telephone 

Supplies 

Disinfecting  Stations 
Cost  of  Operation 
Salaries  and  Wages 
Other  Expenses 
Chemicals 
Fuel 

Field  Work 

Salaries  and  Wages 
Other  Expenses 

Chemicals 

Care  of  Horses 

Repairs  to  Wagons  and  Harness 

Supplies 


♦i 


4> 

t 


Exhibit  6— Continued 


i6i 


Repairs  and  Betterments  to  Plant 

Miscellaneous 

Removal  of  Night  Soil,  etc. 
Support  of  Ambulance  Service 
Abatement  of  Nuisances 


EXHIBIT  6e 


3.  Division  of  Communicable  Diseases 

Executive  Work 

Salaries  and  Wages  \  ^^^  ^^^^j^^  ^^^  commissioner 

Office  and  Other  Expenses 

District  Medical  Inspection 

Inspectors 
Salaries 
Incidentals 
Carfare 
Telephone 
Supplies 

Nurses 

Salaries 
Incidentals 

Carfare 

Telephone 

Supplies 

Clinics 
Salaries  and  Wages 
Nurses 
i  Attending  Physicians 

Medical  Inspectors 
Hospital  Clerks 
Laborers 
Other  Expenses 
Carfare 
Telephone 
Drugs 
Supplies 


{ 


I  I 

I 


162 

Diagnosis  Laboratory 
Salaries  and  Wages 

Assistant  Director 

Bacteriologist 

Bacteriological  Diagnostician 

Laboratory  Assistants 

Clerks 

Laborers  and  Cleaners 
Laboratory  Expense 

Culture  Tubes 

Slides 

Wooden  Boxes 

Sputum  Jars 

Apparatus 

4.  Assistant  Registrar  of  Records 
Salaries  and  Wages 
Office  and  Other  Expenses 
EXHIBIT  6f 

III.  LABORATORIES 

I.  Research  Laboratory 

Administration  and  Research 
Salaries  and  Wages 

Administrative  Head 
Research  Assistants 
Cleaners  and  Laborers 

Other  Expenses 
Transportation 
Traveling  Expenses 
Expressage 
Books  and  Periodicals 
Supplies 

Production  of  Antitoxin 
Salaries  and  Wages 
Other  Expanses 

Board  of  Horses 
Veterinarian's  Fees 
Guinea  Pigs,  Cost  of 
Meat  and  Eggs 
Animal  Food 
Apparatus 
Supplies 


Exhibit  6 — Continued 


» 


See  outline  for  commissioner 


4 


•1 


Exhibit  6— Continued 

Production  Pasteur  Virus  and  Treatment  of  Disease 

Salaries  and  Wages 
Other  Expenses 

Cost  of  Rabbits 

Animal  Food 

Apparatus 

Supplies 

Milk  Analysis 

Salaries  and  Wages 
Other  Expenses 

Bottles 

Petri  Dishes 

Diagnosis  of  Glanders 
Salaries  and  Wages 

2.  Chemical  Laboratory 
Administration 

Salaries  and  Wages 

Administrative  Head 

Assistant 

Cleaners 

"  Transportation 

Traveling  Expense 

Books  and  Periodicals 

Expressage 

Supplies 


i6s 


Other  Expenses 


t 


Water  Analysis 

Salaries  and  Wages 
Other  Expenses 
Apparatus 
Chemicals 
Supplies 

MUk  Analysis 

Salaries  and  Wages 
Other  Expenses 
Apparatus 
Chemicals 
Supplies 


i64 


Exhibit  6 — Continued 


Exhibit  6 — Continued 


165 


EXHIBIT  6g 

Food  Analysis 

Salaries  and  Wages 
Other  Expenses 

Apparatus 

Chemicals 

Supplies 

Miscellaneous  Work 

Salaries  and  Wages 
Other  Expenses 

Apparatus 

Chemicals 

Supplies 

3.  Vaccine  Laboratory 

Administration 

Salaries  and  Wages 

Administrative  Heads 

Assistants 

Cleaners 

Other  Expenses 

Transportation 

Traveling  Expense 

Expressage 

Books  and  PerlOviicah 

Supplies 

Cost  of  Production  of  Vaccine 

Salaries  and  Wages 

Laboratory  Assistants 

Inspectors 

Laborers  and  Cleaners 

Other  Expenses 

Cost  of  Calves 

Cost  of  Food  for  Calves 

Instruments 

Supplies 

Repairs  and  Improvements 


^< 


V 


4.  Drug  Laboratory 

Salaries  and  Wages 

Chemists 

Laboratory    Assistants 

Laborers  and  Cleaners 

Other  Expenses 
Expressage 
Furniture  and  Fittings 
Apparatus 
Repairs 
Waste 

Drugs,  and  Supplies  for  Distribution 

IV.  HOSPITALS 

EXHIBIT  6h 

V.  DEPARTMENTAL  STABLES 

Salaries  and  Wages 

Foreman 

Assistants  (not  including  drivers) 

Stable  Supplies 
Com 
Oats 
Hay 

4c       *       4c 
♦      4(      * 

Repairs  and  Betterments 

VI.  CORPORATE  STOCK 


i66 


184  r-1907 


File  No.. 


Exhibit  7 


Perfect  Score  IOO5C 
Score  Allowed S 


DEPARTMENT  OF  HEALTH 


CITY  OF  NEW  YORK 


I>airy  Inspection 


Division  of  Inspections 


Exhibit  7 — Continued 


167 


1  Inspection  No Time A.  P.  M.  Date 100 

2  Tenant P.  O.  Address — 

3  Township County State 

4  Owner Party  Interviewed _. 

5  Milk  delivered  at Since 

Formerly  delivered  at - 

6  Creamery  on R.  R Branch Miles  to  N.  Y 

7  Creamery  operated  by Address 

8  Distance  of  farm  from  creamery Occupied  farm  since 

9  No.  of  Cows Breed No.  Milking 

Quarts  milk  produced 

10  All  persons  in  the  households  of  those  engaged  in   producing  or  handling  milk 
are free  from  all  infectious  disease — 

11  Date  and  nature  of  last  case  on  farm 

12  A  sample  of  the  water  supply  on  this  farm  taken  for  analysis - 

190 and  found  to  be - 

13  Size  of  cow  barn,  length feet.    Width feet.    Height  of  ceiling 


$ 


Perfect    Allow 


STABLE 

14  COW  STABLE  Is located  on  elevated  jrround  with  no  stagnant 

water,  hog-pen,  or  privy  within  100  feet 

15  FLOORS  are constructed  of  concrete  or  some  non-absorbent  material 

16  Floors  are properly  graded  and  water-tight 

17  DROPS  are constructed  of  concrete,  stone  or  some  non-absorb- 

ent material 

18  Drops  are watertight 

19  FEEDING  TROUGHS,  platforms  or  cribs  are well  lighted  and  clean 

20  CEILING  is  constructed  cl and  is tight  and  dust  proof 

21  Ceiling  is free  from  hanging  straw,  dirt  or  cobwebs 

22  NUMBER  OF  WINDOWS total  square  feet which 

is suttit'ient 

23  Window  panes  are washed  and  kept  clean _ 

24  VENTILATION  consists  of 

_ which  is  sufficient  3,  fair  1,  insufficient© 

25  AIR  SPACE  is cubic  feet  per  cow  which  is sufficient 

(600  and  over-3)  (500  to  600-2)  (100  to  500-1)  (under  400-O) 

26  INTERIOR  of  stable  painted  or  whitewashed  on which  is  satisfactory 

2.  fair  1,  never  O 

27  WALLS  AND  LEDGES  are free  from  dirt,  dust,  manure  or  cobwebs 

28  FLOORS  AND  PREMISES  are free  from  dirt,  rubbish  or 

decayed  animal  or  vegetable  matter 

29  COW  BEDS  are clean 

30  LIVE  STOCK,  other  than  cows,  are excluded  from  rooms  in 

which  milch  cows  are  kept 

31  There  is direct  opening  from  barn  into  silo  or  grain  pit 

32  BEDDING  used  is clean,  dry  and  absorbent 

33  SEPARATE  BUILDING  Is provided  for  cows  when  sick 

34  Separate  quarters  are provided  for  cows  when  calving 

35  MANURE  is removed  daily  to  at  least  200  feet  from  the  bam  ( ft.) 

36  Manure  pile  is so  located  that  the  cows  cannot  get  at  it 


1 
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37  LIQUID  MATTER  is absorbed  and  removed  daily  and allowed 

to  overflow  and  saturate  ground  under  or  arovmd  cow  barn 

38  RUNNING  WATER  supply  for  washing  stables  is located 

within  building 

39  DAIRY  RULES  of  the  Department  of  Health  are posted 


42 

43 

44 
45 

46 
47 
48 

49 

50 


51 
52 
53 
54 
55 
56 
57 
58 
59 

60 


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64 

65 

66 
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70 
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72 


73 

74 

75 


COW  TARD 

40  COW  TARD  Is properly  graded  and  drained. 

41  Cow  yard  is clean,  dry  and  free  from  manure.... 


COWS 

COWS  have been  examined  by  Veterinarian ^ 

Date 190 Report  was 

Cows  have been  tested  by  tuberculin,  and  all  tuberculous  cows  removed 

Cows  are all  in  good  flesh  and  condition  at  time  of  inspection 

Cows  are all  free  from  clinging  manure  and  dirt.    (No.  dirty ) 

LONG  HAIRS  are kept  short  on  belly,  flunks,  udder  and  tail 

UDDER  AND  TEATS  of  cows  are thoroughly  cleaned  before  milking 

ALL  FEED  Is of  good  quality  and  all  grain  and  coarse  fodders 

are free  from  dirt  and  mould 

DISTILLERY    waste  or    any  substance    in    a    state    of   fermentation    or 

putrefaction  Is fed 

WATER  SUPPLY  for  cows  is unpoUuted  and  plentiful 

MILKERS  AND  MILKING 

ATTENDANTS  are in  good  physical  condition 

Special  Milking  Suits  are used 

Clothing  of  milkers  is clean 

Hands  of  milkers  are washed  clean  before  milking 

MILKING  is done  with  dry  hands 

FORE  MILK  or  first  few  streams  from  each  teat  is discarded 

Milk  is  strained  at and in  clean  atmosphere 

Milk  strainer  Is clean _ 

MILK  is cooled  to  below  50"  F.  within  two  hours  after  milking 

and  kept  below  50°  F.  until  delivered  to  the  creamery " 

Milk  from  cows  within  15  days  before  or  5  days  after  parturition  is discarded 

UTENSILS 
MILK  PAILS  have all  seams  soldered  flush 

Milk  pails  are of  the  small  mouthed  design,  top  opening  not 

exceeding  8  inches  in  diameter.    Diameter 

Milk  pails  are rinsed  with  cold  water  immediately  after  using  and 

washed  clean  with  hot  water  and  washing  solution 

Drying  racks  are provided  to  expose  milk  pails  to  the  sun 

MILK  HOUSE 
MILK  HOUSE  Is located  on  elevated  ground  with  no  hog-pen, 

manure  pile  or  privy  within  100  feet 

Milk  house  has direct  communication  with _ building 

Milk  house  has sufficient  light  and  ventilation 

Floor  is properly  graded  and  water-tight 

Milk  house  is free  from  dirt,  rubbish  and  all  material  not  used  in  the 

handling  and  storage  of  milk 

Milk  house  has running  or  still  supply  of  pure  clean  water 

Ice  Is used  for  cooling  milk  and  is  cut  from 

WATER 
WATER  SUPPLY  for  utensils  is  from  a located 

feet  deep  and  apparently  is pure,  wholesome 

and  uncontaminated „ _ 

Is protected  against  flood  or  surface  drainage 

There  Is privy  or  cesspool  within  250  feet  ( ^ feet)  of  source  of 

water  supply „ _ „ 

There  Is stable,  bam-yard,  or  pile  of  manure  or  other  source  of 

contamination  within  200  feet  ( feet)  of  source  of  water  supply 


Perfect 


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1587,    07,  50.000  (P) 


Insyector  of  Foods 


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Exhibit  7 — Continued 


169 


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CREAMERY  is located  on  dry  and  elevated  ground 

1»  at  least  100  feet  away  from  any  hog-pen,  privy-vault,  factory, 

manure  loading  platform  or  anything  else  objectionable 

Premises  surrounding  creamery  are clean 

RECEIVING  ROOM  Is partitioned  off  from  main  milk  room 

Air  is free  from  dust,  dirt  or  objectionable  odors 

Weigh  vats  and  storage  tanks  are....~ covered 

MILK  HANDLING  ROOM  Is used  exclusively  for  handling  milk 

Xa separate  from  where  cans  are  washed 

l^[",",,", separate  from  where  engine  or  boiler  is  located - 

Ig well  lighted  by windows 

Has good  ventilation - 

All  odors  and  steam  from  washing  apparatus  are carried  off 

WALLS  AND  CEILING  are....„ sheathed  and  dust  tight 

Are painted  with  some  light  colored  paint 

All  ledges  are clean  and  free  from  dust  and  dirt 

FLOORS  are free  from  dirt,  rubbish  or  pools  of  drainage 

Are made  of  concrete,  stone  or  some  non-absorbent  material 

Are water-tight 

Are so  graded  that  ali  drainage  is  discharged  at  one  or  more  points 

Strainers  In  floor  are at  least  12  Inches  in  diameter ~ 

SPACE  BENEATH  CREAMERY  is dry 

jg  free  from  ivaste  or  rubbish — 

DRAINS  are of  earthenware  or  iron 

Are water-tight 

Are continuous  from  the  floor  level  to  point  of  disposal 

Are    protected  against  freezing 

DRAINAGE  Is satisfactorily  disposed  of 

Discharged  into  a  stream 

Discharged  into  a  covered  cesspool  and  pipes  properly  trapped 

Land  disposal  at  least  500  feet  away  from  creamery 


PiBrKCT 
SCOBK 


,  be  readily  taken  apart 


MILK  PUMPS  AND  PIPES  for  milk,  can 

Are thoroughly  cleaned  daily 

All  steam  and  water  pipes  are painted  and  clean 

STORAGE  TANKS  OR  MIXING  VATS  are Jn  good  repair 

All  tin  joints  are soldered  flush 

Are thoroughly  cleaned  daily 

MILK  CANS  are washed  with  hot  water  and  washing  solution 

Are rinsed  out  with  clean  water 

Are exposed  to  live  steam  for  at  least  two  minutes 

ALL  MILK  Is protected  from  dust  and  dirt  while  in  pools 

Ig protected  while  in  mixing  vats  or  over  aerators 

Ig  received  at  a  temperature  not  above  60°  F 

Is.«"."..".-..-kept  below  50°  while  held  or  handled  on  premises 

COOLING  TANKS  are water-tight 

Are    made  of  some  non-absorbent  material 

jiie][,"..... supplied  daily  with  clean  water  or  filled  with  clean  Ice 

WATER  SUPPLY  Is  ample  for  all  the  needs  of  the  creamery 

Water  supply  is apparently  free  from  all  contamination  and  Is  from 

__  ___ — ................................ 

ICE  POND  is polluted  by  privy  or  creamery  waste 

STORAGE  TANK  for  water  is cleaned  regularly 

jg covered  or  protected  against  dirt ~. 

ATTENDANTS  are cleanly  in  their  habits 

Garments  worn  by  such  employees  are clean 

PRIVY,  water  closet,  earth  closet,  tight  vault  Is satisfactorily  located 

Ig in  a  cleanly  condition 

SPITTING  OR  SMOKING  In  any  part  of  the  building  Is allowed 


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Inspector  of  Voo<]t 


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\ii 


BUREAU    OF  MUNICIPAL   RESEARCH 


HISTORY 

January  ist,  1906    Organized  as  "  Bureau  of  City  Betterment  " 

May  3d,  1907  Incorporated  as  "Bureau  of  Municipal  Research  " 

PURPOSES 

To  promote  efficient  and  economical  municipal  government ;  to  promote 
the  adoption  of  scientific  methods  of  accounting  and  of  reporting  the 
details  of  municipal  business,  with  a  view  to  facilitating  the  work  of 
public  officials ;  to  secure  constructive  publicity  in  matters  pertaining 
to  municipal  problems  ;  to  collect,  to  classify,  to  analyze,  to  correlate, 
to  interpret  and  to  publish  facts  as  to  the  administration  of  municipal 
government. 

REPORTS,   JANUARY,  1906,  to  AUGUST,  1907 

Some  Phases  of  the  Work  of  the  Department  0/ Street  Cleaning 
(in  print) 

City  Owned  Houses 

Led  to  the  appointment  of  a  commission  by  the  mayor  to  devise  a 
method  of  abolishing  and  preventing  the  recurrence  of  unsanitary  and 
illegal  conditions  found  in  tenements  owned  by  the  city. 

Salary  Increases  Not  Provided  for  in  Budget 

Inefficiency  of  Inspection  of  Combustibles 
Led  to  the  dismissal  of  superintendent. 

The  City  of  New  York,  the  Street  Railroad  Companies  and  a  Million  and 
a  Half  Dollars 

Led  to  the  establishment  of  a  special  bureau  in  the  city's  law  depart- 
ment to  take  up  and  press  the  claims  of  the  city  against  street  railroad 
companies  for  paving  done  at  the  public's  expense  between  the  com- 
panies' rails. 

How  Manhattan  is  Governed 

Led  to  investigation  by  the  commissioners  of  accounts,  upon  whose 
findings  the  City   Club  brought  charges   before    Governor    Hughes 
-  demanding  the  removal  of  Borough  President  Ahearn.     Hearing  set 
for  September  loth. 

Analysis  of  the  Salary  Expenditure  of  the  Department  of  Health  of  the 
City  of  Netv  York  for  the  Year  i gob 

Led  to  the  adoption  of  the  principle  bv  the  board  of  aldermen  and  the 
board  of  estimate  and  apportionment  that  future  budgets  should  clearly 
indicate  for  what  specific  purposes  the  money  voted  is  to  be  expended. 

Making  a  Municipal  Budget ;    Functional  Accounts  and  Records  for  the 
Department  of  Health     ( in  pri  n  t ) 

A  Department  of  Municipal  Audit  and  Examination  ;  Report  on  the  Office 
of  Commissioners  of  Accounts 

Re-organization  effected  by  the  commissioner,  with  the  approval  of 
the  mayor. 


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